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LTC CREDIT APPLICATION


Company Information:
Name of Business:  
Phone:
(Enter As: XXX-XXX-XXXX)
    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:
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:

Your Contact at LTC:

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