Credit Application

LTC Credit Application

Company Information:

Name of Business:

Phone:

Ext:

Contact Name:

Fax:

Address

City:

State: Zip: Country:

E-mail:

Trade Name or DBA/AKA:

Invoicing Information:

Address

City:

State: Zip:

Country:

Type of Business:

Corporation Partnership Individual

Years in Business:

D-U-N-S Number:

Approx. # of Shipments per Month:

Inbound: Outbound:

Billing Requirements

Does your company accept electronic invoicing? Pay by:

Credit terms are 30 days. If you do not pay
within 30 days, what are your terms?

Individual or department responsible for the payment of freight charges:

Phone:

Ext:

Fax:

E-mail:

Please describe your approval process from receipt to release of payment:

Parent Company Information, If Applicable

Company Name:

Phone:

Ext:

Fax:

Address

City:

State: Zip: Country:

Credit References:

Vendor Business Name:

Phone:

Ext:

Fax:

Address

City:

State: Zip: Country:

Vendor Business Name:

Phone:

Ext:

Fax:

Address

City:

State: Zip: Country:

Carrier Business Name:

Phone:

Ext:

Fax:

Address

City:

State: Zip: Country:

Carrier Business Name:

Phone:

Ext:

Fax:

Address

City:

State: Zip: Country:

*Please provide two carrier references

Additional Information:

Has your company ever filed bankruptcy?

Has your company ever had legal activity taken against it?

If yes, please explain:

Individual completing application:

E-mail:

Title/Position:

Phone:

Ext:

Date:

Additional Comments:

All information provided to LTC will only be used internally. LTC is committed to preserving your privacy.

RCMS Certified

LTC Corporate Headquarters
8470 Allison Pointe, St 400, Indianapolis, IN 46250
Voice: 317-841-4200, Fax: 317-841-8259
Load Planning Center E-mail: lpc@liquidtransport.com.
Questions or comments, please contact our Webmaster
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