Credit Application

Credit Application Form

"*" indicates required fields

Business Information

Business Name*

Phone*

Business Email*

Fax

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nature of Busines*

Type of Business*

Annual Sales*

Number of Employees*

Number of Trips Required (annually) & Expected Frequency*

GST Number*

Limit Requested*

Preferred Method of Payment*

Purchase Order Require/Issues*

Yes

*Note, invoices are set to send via email, please request alternate arrangements if necessary.

Special Instructions

Contact Information

KEY CONTACT PERSONS

Contact Person 1*

First Last

Title*

Phone*

Email*

Contact Person 2

First Last

Title

Phone

PRINCIPAL(S) / OFFICER(S) / – (NAME / TITLE / % OWNERSHIP)

Name

First Name Last Name

Title

Ownership

Name

First Name Last Name

Title

Ownership

Name

First Name Last Name

Title

Ownership

References

BANK REFERENCES

Bank Name*

Account No.*

Branch Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

BUSINESS REFERENCES

Reference 1*

Contact Name*

Email*

Phone*

Reference 2

Contact Name

Phone

Agreement

Full Name for Agreement*

agreement

By selecting this box you agree with the terms and conditions listed below; and that you have answered all the questions above to the best of your knowledge; and that Astro Transport will use this information to process your credit application.

Terms are net 30 days subject to credit approval. Overdue accounts are subject to interest charges of 2% per month (24% per annum). After 90 days, accounts may be placed for collections and reported to credit bureaus.
Invoicing discrepancies must be reported in writing within 72 hours after receipt.
I authorize any of the above credit references to release credit information to Astro Transport.
Astro Transport shall not be liable for loss, damage, or delay caused by acts of God, terrorism, public authorities, strikes, labor disputes, weather, mechanical failures, or civil commotions

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Name

This field is for validation purposes and should be left unchanged.

Credit Application

SIMPLIFY YOUR BUSINESS WITH A CREDIT ACCOUNT.