Open Account

Credit Application Form

Company's Legal Name *

Phone *

Fax

Mailing Address *

City

Province

Postal Code

Country

Accounts Payable Contact

Phone

Email Address

Freight Manager

Phone

Email Address

Shipping Address (If Different)Shipping Address (If Different)

Street Address

City

Province

Postal Code

Country

I require a Purchase Order/Reference Number

Principle Partners

Name

Phone

Name

Phone

Supplier References

(Other Than Transportation Companies)

Name

Address

Phone

Fax

Name

Address

Phone

Fax

Bank References

Name

Branch

Name

Branch

Insurance

Insurance *

As per the Motor Carrier Act, freight will be covered at $2.00 per pound unless a higher value has been declared on the face of the waybill by the consignor. Declared Value insurance will be charged at $0.75 per $100.00 of declared value.
Maximum declared value per shipment is $5000.00 without prior authorization in writing.

Credit Terms *

Accounts are due and payable within fifteen (15) days of receipt of invoice. Past due accounts are subject to cancellation of credit
without notice and subsequent third party collection action. All charges must be paid before any service disputes can be settled. service charge of 2% per month may be charged on past due accounts.

Consent *I hereby authorize Strait Express Ltd to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business requirement

Name *

Position

Date *

Check All That ApplyYES, I wish to be signed up for Internet Order EntryYES, I wish to be signed up for Email BillingYES, I wish to make payments by Direct Deposit

Email Address