Credit Application — Amtrix Global Freight

Secure Online Form

Credit Application

Complete the form below to apply for a credit account with Amtrix Global Freight. All information is encrypted and reviewed within 2 business days.

I have a pre-prepared credit packet. Customers with a complete credit packet may check this box, skip the form, and upload documents below.

AGF Agent / Sales Person

Contact Information

Legal Name of Business

DBA Name

Date of Incorporation

State of Incorporation

Officer Name

Officer Title

Officer Phone

Officer Email

Street Address

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Accounts Payable

A/P Contact

A/P Email

A/P Phone

A/P Fax

Business Details

Type of Entity

Type of Business

Years in Business

Federal ID #

D & B #

No. of Employees

Annual Revenue

Billing Information

Billing Company Name

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Billing Contact

Billing Email

Billing Phone

Email for Sending Invoices

Banking & Credit References

Bank Name

Bank Officer

Bank Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Bank Contact

Years of Relationship

Bank Phone

Bank Email

Account #

Trade Reference 1

Creditor Name

Creditor Contact

Creditor Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Years of Relationship

Creditor Phone

Creditor Email

Upload Documents

Click to upload or drag & drop

PDF, DOC, XLS, JPG, PNG, ZIP — up to 10MB each

Consent. We understand and will comply with regulations requiring payment of all freight charges within thirty (30) days of receipt of statement.

By submitting you confirm the information provided is accurate.

Credit Application — Amtrix Global Freight

Amtrix Global Freight

Secure Online Form

Credit Application

Complete the form below to apply for a credit account with Amtrix Global Freight. All information is encrypted and reviewed within 2 business days.

I have a pre-prepared credit packet

Customers with a complete credit packet may check this box, skip the form, and upload documents below.

AGF Agent / Sales Person*

Contact Information

Legal Name of Business* DBA Name* Date of Incorporation State of Incorporation Officer Name Officer Title Officer Phone Officer Email*

Street Address

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country*

Accounts Payable

A/P Contact A/P Email* A/P Phone A/P Fax

Business Details

Type of Entity Type of Business Years in Business Federal ID # D & B # No. of Employees

Annual Revenue

Billing Information

Billing Company Name Billing Address Line 1 Billing Address Line 2 Billing City Billing State Billing ZIP Billing Country Billing Contact Billing Email* Billing Phone

Email for Sending Invoices*

Banking & Credit References

Bank Name Bank Officer Bank Address Bank Address Line 2 Bank City Bank State Bank ZIP Bank Country Bank Contact Years of Relationship Bank Phone Bank Email*

Account #

Trade Reference 1

Creditor Name Creditor Contact Creditor Address Creditor Address Line 2 Creditor City Creditor State Creditor ZIP Creditor Country Years of Relationship Creditor Phone

Creditor Email*

Upload Documents

Click to upload file

PDF, DOC, XLS, JPG, PNG, ZIP — up to 10MB

Consent. We understand and will comply with regulations requiring payment of all freight charges within thirty (30) days of receipt of statement.

By submitting you confirm the information provided is accurate.

form-work

Credit Application

Contact Information

Street Address

Accounts Payable

Business Details

Billing Information

Banking & Credit References

Trade Reference 1

Upload Documents

Credit Application

Contact Information

Street Address

Accounts Payable

Business Details

Billing Information

Banking & Credit References

Trade Reference 1

Upload Documents

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