New Customer Profile and Credit Application

New Customer Profile and Credit Application
Please complete form in its entirety. If applicant has pre-packaged trade & bank references please complete items 1 thru 19 and 24-26. Use upload buttons to attach your documents.
1. Company Legal Name *
2. Additional Company Names, Affiliates, Alias' or d/b/a
3. State or Province Incorporated *
4. Your Location Description *
5. Authorized Representative Requesting Account *

First Name Last Name
6. Title *
7. Your Email *
8. Your Phone # *
9. Your Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
10. Billing Address if Different from Above

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
11. Organization Type *

Corporation LLC Partnership Sole Proprietor
12. CEO or Owner's Name *

First Name Last Name
13. Operations Contact *
14. Operations Contact Email *
15. TSA/Security/Compliance Contact

First Name Last Name
16. TSA/Security/Compliance Contact Email
17. CFO or Accounts Payable Contact *

First Name Last Name
18. CFO or Accts Payable Contact Email *
19. Email Address for Receiving Invoices & Supporting Documents *
20. List Three Transportation Trade References, Address, and Phone# or Upload Trade Reference Below
21. Upload Trade References
22. Banking Information - Bank Name, Contact, Phone# or Upload Banking Info Below
23. Upload Banking Information

Upload a File

Cancel of
24. DOT#, MC#, or FF# *
Enter N/A if this does not apply to your organization
Remit/Payment Address:

Cargo King Express

3171 SW 20th Court

Ft. Lauderdale, FL 33312
The information provided in this application shall not be shared and is kept confidential
I certify that by signing this form below that the information and any documents uploaded herein are true and correct and that I agree and accept Cargo King Express' "Terms and Conditions"
25. Authorized Representative's Name *

First Name Last Name
26. Authorized Signature - Use Mouse to Sign *
*
Don't forget to upload your document(s) if any, and thank you for the opportunity to serve you!
Should be Empty: