GlobalTranz Credit Card App – Associated Shippers

Check One *

Corporation
LLC
Proprietorship
Other

Applicant Exact Legal Name of Business: *

Physical Address, City, State & Zip of Business: *

Billing Address, City, State & Zip if different from Physical

Shipping Address, City, State & Zip if different from Physical

Name of owner of Credit Card *

Credit Card owner's Email: *

Confirm Email

Accounts Payable Phone Number & Fax *

First

Last

Primary Shipping Needs (Check one) *

LTL (Less than Truckload)
Truckload

Please attach a list of any other locations or business names and addresses that you want to be able to ship & receive under your account, if any.

THE ABOVE INFORMATION is for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize the company to whom this application is made to investigate the references pertaining to my/our credit and financial responsibility. You agree to accept electronic signatures and/or faxed copies of this document as creating legal effect. THE AUTHORIZED SIGNATORY SIGNING THIS APPLICATION ON BEHALF OF ITS COMPANY CONSENTS AND BINDS ITS COMPANY TO THE TERMS AND FOUND AT https://carrierrate.globaltranz.com/CR2/DocumentViewer/GetTermsAndConditions (To access Terms and Conditions), goto the link at bottom of this page.

Electronic Authorized Signatory & Title *

First

Last

Electronic Authorized Signatory (The authorized signatory agrees that you have the powers to commit your organization to a binding agreement):

Print Signature Name & Date Signed *

First

Last

Phone