Credit Application

Applicant Information

Applicant Company Name *
Address *
Address 2
City *
State *
Zip Code *
Telephone *
Fax
Accounting Contact *
Accounting Email *
DUNS # *

Billing/Invoice Requirements

Do you require a reference number?*

Other Billing/Invoicing Requirements

Is an outside company processing your payables?*

If yes, please complete below:

Payables Co Name
Payables Co Phone
Payables Co Contact Name
Payables Co Email

Credit Information

Credit Line Requested ($) *
Annual Revenue ($) *
IRS/Fed Tax ID # *
Type of Business *
Years in Business *
Total # of Employees *
Any Legal Filings? *
Any Bankruptcies? *
Any Judgements? *
Any Liens? *

Officers

Name
Title
Name
Title

BANK REFERENCES (Note: If bank charges occur, they will be your responsibility.)

Name/Branch *
Telephone # *
Account # *
Contact *

TRADE REFERENCES

Company Name *
Telephone # *
Email *
Account # *
Contact *
Company Name
Telephone #
Email
Account #
Contact
Company Name
Telephone #
Email
Account #
Contact

On behalf of the applicant: I hereby give written consent to Steven Global Logistics, Inc. to obtain credit information from any of the references listed above. I certify that I agree with the payment terms in consideration of extended credit. Payment will be made per invoice terms. In the event of noncompliance with your terms, I agree the applicant will pay all attorney/collection fees as assessed. I acknowledge receipt of the governing Terms and Conditions of Service herewith - (Terms & Conditions) - and I agree the applicant will be bound by the same. All information will be held in strictest confidence. Return the completed application directly to Stevens Global Logistics, Inc.

Terms and Conditions of Service
Claimant Signature (type name) *
Date of Signing *
Claimant Phone *
Claimant Email *
Claimant Address *

Questions? Please give us a call at 808.834.7606 or Contact Us