Company Information and Credit Application

COMPANY INFORMATION
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Does your company have a DUNS Number?
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Billing Preference
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Documentation required with invoice
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Invoicing Requirements:
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Preferred Method of Payment :
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Remittance Information:International Transload LogisticsPO Box 5724Naperville, IL 60567
Wire Information:American Chartered Bank1199 E. Higgins RdSchaumburg, IL 60173(847)517-2267 Account: 1243637Routing: 071-925-046Swift Code: AMCDUS41Wire Address: P.O. Box 5724 Naperville, IL 60567 
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BANK INFORMATION
Are you providing your own bank information and credit reference form?
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BUSINESS REFERENCES Please provide information for three companies with whom your business has established credit.
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Credit Agreement 1. All invoices must be paid within 30 days of the date issued unless other terms are negotiated.2. Any claims regarding an invoice issued must be made within 7 days of the date issued.3. You authorize inquiry into the banking and businesses provided within this application.
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Company Information and Credit Application

COMPANY INFORMATION
Please tell us how you heard about International Transload Logistics?
Sales Person
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Company Name:
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Does your company have a DUNS Number?
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DUNS #:
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Address:
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City:
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State:
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Zip:
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Phone:
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Fax:
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Business Type:
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Billing Preference
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Accounts Payable Contact
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Accounts Payable E-mail
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Accounts Payable Phone
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Billing E-mail Address 1
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Billing E-mail Address 2
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Billing E-mail Address 3
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Mail Invoice to:
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Address:
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City:
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State:
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Zip:
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Documentation required with invoice
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Invoicing Requirements:
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Notification E-mail 1
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Notification E-mail 2
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Notification E-mail 3
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Notification E-mail 4
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Notification E-mail 5
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Form Image Element
Preferred Method of Payment :
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Remittance Information:International Transload LogisticsPO Box 5724Naperville, IL 60567
Wire Information:American Chartered Bank1199 E. Higgins RdSchaumburg, IL 60173(847)517-2267 Account: 1243637Routing: 071-925-046Swift Code: AMCDUS41Wire Address: P.O. Box 5724 Naperville, IL 60567 
Form Image Element
BANK INFORMATION
Are you providing your own bank information and credit reference form?
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Add Attachment
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Bank Name:
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Contact:
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Address:
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City:
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State:
{binding displayValue}
Zip:
{binding displayValue}
Phone:
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Account#:
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BUSINESS REFERENCES Please provide information for three companies with whom your business has established credit.
Company:
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Contact Name:
{binding displayValue}
Title:
{binding displayValue}
E-mail:
{binding displayValue}
Address:
{binding displayValue}
City:
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State:
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Zip:
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Phone:
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Fax:
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Form Image Element
Company:
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Contact Name:
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Title:
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E-mail:
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Address:
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City:
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State:
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Zip:
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Phone:
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Fax:
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Form Image Element
Company:
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Contact Name:
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Title:
{binding displayValue}
E-mail:
{binding displayValue}
Address:
{binding displayValue}
City:
{binding displayValue}
State:
{binding displayValue}
Zip:
{binding displayValue}
Phone:
{binding displayValue}
Fax:
{binding displayValue}
Credit Agreement 1. All invoices must be paid within 30 days of the date issued unless other terms are negotiated.2. Any claims regarding an invoice issued must be made within 7 days of the date issued.3. You authorize inquiry into the banking and businesses provided within this application.
Signature:
Name:
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Email*:
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Title:
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Date:
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Form Image Element
Notes & Comments:

Company Information and Credit Application

COMPANY INFORMATION
Please tell us how you heard about International Transload Logistics?
Sales Person
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Company Name:
{binding displayValue}
Does your company have a DUNS Number?
{binding displayValue}
DUNS #:
{binding displayValue}
Address:
{binding displayValue}
City:
{binding displayValue}
State:
{binding displayValue}
Zip:
{binding displayValue}
Phone:
{binding displayValue}
Fax:
{binding displayValue}
Business Type:
{binding displayValue}
Billing Preference
{binding displayValue}
Accounts Payable Contact
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Accounts Payable E-mail
{binding displayValue}
Accounts Payable Phone
{binding displayValue}
Billing E-mail Address 1
{binding displayValue}
Billing E-mail Address 2
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Billing E-mail Address 3
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Mail Invoice to:
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Address:
{binding displayValue}
City:
{binding displayValue}
State:
{binding displayValue}
Zip:
{binding displayValue}
Documentation required with invoice
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Invoicing Requirements:
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Notification E-mail 1
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Notification E-mail 2
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Notification E-mail 3
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Notification E-mail 4
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Notification E-mail 5
{binding displayValue}
Form Image Element
Preferred Method of Payment :
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Remittance Information:International Transload LogisticsPO Box 5724Naperville, IL 60567
Wire Information:American Chartered Bank1199 E. Higgins RdSchaumburg, IL 60173(847)517-2267 Account: 1243637Routing: 071-925-046Swift Code: AMCDUS41Wire Address: P.O. Box 5724 Naperville, IL 60567 
Form Image Element
BANK INFORMATION
Are you providing your own bank information and credit reference form?
{binding displayValue}
Add Attachment
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
Bank Name:
{binding displayValue}
Contact:
{binding displayValue}
Address:
{binding displayValue}
City:
{binding displayValue}
State:
{binding displayValue}
Zip:
{binding displayValue}
Phone:
{binding displayValue}
Account#:
{binding displayValue}
BUSINESS REFERENCES Please provide information for three companies with whom your business has established credit.
Company:
{binding displayValue}
Contact Name:
{binding displayValue}
Title:
{binding displayValue}
E-mail:
{binding displayValue}
Address:
{binding displayValue}
City:
{binding displayValue}
State:
{binding displayValue}
Zip:
{binding displayValue}
Phone:
{binding displayValue}
Fax:
{binding displayValue}
Form Image Element
Company:
{binding displayValue}
Contact Name:
{binding displayValue}
Title:
{binding displayValue}
E-mail:
{binding displayValue}
Address:
{binding displayValue}
City:
{binding displayValue}
State:
{binding displayValue}
Zip:
{binding displayValue}
Phone:
{binding displayValue}
Fax:
{binding displayValue}
Form Image Element
Company:
{binding displayValue}
Contact Name:
{binding displayValue}
Title:
{binding displayValue}
E-mail:
{binding displayValue}
Address:
{binding displayValue}
City:
{binding displayValue}
State:
{binding displayValue}
Zip:
{binding displayValue}
Phone:
{binding displayValue}
Fax:
{binding displayValue}
Credit Agreement 1. All invoices must be paid within 30 days of the date issued unless other terms are negotiated.2. Any claims regarding an invoice issued must be made within 7 days of the date issued.3. You authorize inquiry into the banking and businesses provided within this application.
Signature:
Name:
{binding displayValue}
Email*:
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Title:
{binding displayValue}
Date:
{binding displayValue}
Form Image Element
Notes & Comments:
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