SHIPPER CREDIT APPLICATION "*" indicates required fields Customer InformationBusiness Name* Address* Street Address City State Zip Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone Number*Fax* DUNS # Fed ID #* MC# Type of Business*DistributionManufacturingRetailOtherWebsite Date Business Started* MM slash DD slash YYYY Number of Employees* Annual Sales* Credit References1 - Company Name* 1 - Contact Name* 1 - Phone Number* 1 - Email* 2 - Company Name* 2 - Contact Name* 2 - Phone Number* 2 - Email* Billing Information Business Name* Accounts Payable Contact Name* Phone Number*Email* Fax* Billing Inclusions and Attachments Inclusions - Check the appropriate box if this information must appear on the Invoice.* Customer Reference Bill of Lading Other None If you selected “Other” that needs to appear on the Invoice, please explain what else you would like to be included. Attachments - Check the appropriate box if this document needs to be attached to the Invoice.* Signed POD Confirmation Sheet Accessorial Receipt(s) Other None If you selected “Other” for documents that need to be attached to the Invoice, please explain what else you would like to be attached. Email Billing Our preferred method of billing is email. This allows us to send electronic invoice statements that will make payments simple. Upon request, supporting documents will be provided, along with a copy of scanned images. Email address you would like Invoices sent to:* Other notes to assist us in emailing your invoices: E-Signature*Title* Date (MM/DD/YYYY)* MM slash DD slash YYYY This information is given to obtain an open account status. The person submitting this application/executing this agreement agrees that the company he/she represents will make full payment to EDGE-2-EDGE LOGISTICS GROUP INC, upon receipt of invoice, but in no case later than thirty (30) days following date of invoice. By submitting this form, permission is granted to EDGE-2-EDGE LOGISTICS GROUP INC to inquire about this company's credit worthiness from any source. The person submitting this application/executing this agreement agrees that the company he/she represents will pay all collections/attorney's fees if this account is placed for collection. The person submitting this application/executing this agreement agrees that the company he/she represents must notify EDGE-2-EDGE LOGISTICS GROUP INC in writing, and by certified mail of any change in ownership, the name, or the business structure under which credit is established. The person submitting this application/executing this agreement has authority to bind the company he/she represents and is authorized by that company to enter into the credit application process and are subject to EDGE-2-EDGE LOGISTICS GROUP INC Terms and Conditions. The person submitting this application/executing this agreement acknowledges that entering his/her name into the "E-Signature" field is equally binding as a physical signature and will be liable as such. The person submitting this application/executing this agreement certifies that the above information is as complete, accurate, and true to the best of his/her knowledge. The purpose of this form is to gather information which will help our companies work together smoothly through the billing and collection process. Please do not hesitate to contact us if there is anything we can do to better serve you. Please review the entire form to ensure it is complete and use the "Submit" button below to submit this Online Credit Application. CAPTCHA
