test BUSINESS CONTACT INFORMATION Title: Company Name: Phone: Fax: E-mail: Registered company address: City: State: ZIP Code: Date business commenced: Proprietorship:Partnership:Corporation:Other: BUSINESS AND CREDIT INFORMATION Primary business address: City: State: ZIP Code: How long at current address? Telephone: Fax: E-mail: Bank name: Bank address: Phone: City: State: ZIP Code: Type of account: SavingsCheckingOther Account number: BUSINESS/TRADE REFERENCES Company name Address: City: State: ZIP Code: Phone: Fax: E-mail: Type of Account: AGREEMENT 1. All invoices are to be paid 30 days from the date of arriva 2. Claims arising from invoices must be made within seven working days. 3. By submitting this application, you authorize Direct Xpress Logistics, Inc. to make inquiries into the bankingand business/trade references that you have supplied. 4. By signing this application you accept Direct Xpress Logistics, Inc. Terms & Conditions SIGNATURES Printed Name: Signature Name Δ
