Credit Application

Company Information
Business Name*
Business or Organization
Business Role*
Owner, Manager, etc.
How long in business:*
Phone*
Fax*
Email*
D & B Number*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
BTI Dispatcher/Sales Rep*
Operations/Transportation Email Address*
Billing Address if Different
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Invoice Notification
Would you like invoices and BOL's sent via email?*
- Yes
- No
If yes, where should we send them?
Billing/AP
Name*
First Last
Phone*
Fax
Billing Email Address*
Trade References
Company Name*
Contact*
Name
Phone*
Company Name*
Contact*
Name
Phone*
Company Name
Contact
Name
Phone
Transportation References
Company Name*
Contact*
Name
Phone*
Company Name*
Contact*
Name
Phone*
Company Name
Contact
Name
Phone
Bank References
Name*
Address*
Account Number*
Name
Address
Account Number
Pending lawsuits against company:
Attach documents you would like us to review:
Attach documents you would like us to review:
Attach documents you would like us to review:
Signature*
The undersigned authorizes inquiry as to credit information. We further acknowledge that credit privileges, if granted, may be withdrawn at any time. By typing your name below, you agree and understand that this will take the place of an actual signature and will be accepted the same as if an actual signature were captured. All services by Blakeman Transportation, Inc. (BTI) are provided pursuant to BTI’s Terms and Conditions which are available for inspection and review on our website at here.
Date*
MM
DD
YYYY

Company Information

Billing Address if Different

Invoice Notification

Billing/AP

Trade References

Transportation References

Bank References

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TESTIMONIALS

BLAKEMAN TRANSPORTATION, INC.