M&T Logistics Inc

Credit Request Form

Business Information

Legal Company Name
Address Line 1
Address Line 2
City
State/Province
Zip
Phone #
Fax #
E-Mail Address

Billing Information

Name
ATTN
Address Line 1
Address Line 2
City
State/Province
Zip
Phone #
Fax #

Accounts Payable Contact Information

First Name
Last Name
E-mail
Phone #
Name of Principals
Principals Phone #
Name of Bank
Bank Phone #

Freight Carrier References -(Please List 3)

Reference 1 Name

Reference 1 Phone #

Reference 2 Name

Reference 2 Phone #

Reference 3 Name

Reference 3 Phone #

Current Financial Information

Financial statements will be of great assistance to us in establishing a credit limit for you. Please mail or fax any pertinent financial statements to M&T Logistics, Inc. with the completed and signed application.

Billing Requirements

Please list any special Billing Requirements you may have regarding payment of Freight Bills or any additional comments that you feel will help with the processing of this request.

Disclaimer

We certify that all of the information on this form is correct and that we fully understand the credit terms that all freight charges are due 30 days from receipt of freight bill. We agree to pay accordingly in consideration of extended credit.