The undersigned Applicant wishes to establish credit privileges with Horizon Logistics, LLC. or any successor, subsidiary or affiliate (Horizon Logistics) for the purpose of paying freight invoices and all charges due within the boundaries of this Agreement. In consideration of granting credit Applicant hereby undertakes and unconditionally agrees to the conditions contained in this application and Agreement for credit.

If a field is not relevant to you, please input N/A.

For timely processing, this form must be completed and submitted online. A copy of the completed credit application will be sent to the email address provided on the next page.

 (*) Required Fields

Company Contact Information
*Company Name *D.B.A.
*Street Address
*City *State   *Zip 
*Telephone Nr Facsimile Nr
Mailing Address
(if different than above)

Billing Address Information
Company Name Contact Name
Department Telephone Number
Address Facsimile Number
City State   Zip 

Company Type and Structure

*Please indicate how your company is organized by checking one of the following and provide Federal tax ID:
Sole Proprietorship
Social Security Number
Partnership
General  Limited  Other  Please explain:
Corporation
Date of Incorporation State of Incorporation
*Federal tax ID    
SIC Code *Nature of Business
*Your company's gross annual revenue $ *Year Business Started

Furnish name, mailing address and state of incorporation of Parent Company (if applicable)
Principals name and title
Name Title
Name Title
Name Title

Previous Business History
Do you have a Horizon Logistics Sales Representative?
Yes No
If Yes, please provide the name of your Sales Representative, if known:

Credit Information
To determine the seasonal nature of your shipping needs, please indicate your estimated Number of Shipment by Quarter
First Quarter Second Quarter Third Quarter
Fourth Quarter Total
Desired Monthly Credit Limit    

Trade Credit Reference Information
List three (3) credit references including account numbers
*Name *Name
*Address *Address
*City *City
*State and Zip code *State and Zip code
*Contact Name *Contact Name
*Phone Number *Phone Number
*Facsimile Number *Facsimile Number
*Account Number *Account Number
   
*Name
*Address
*City
*State and Zip code
*Contact Name
*Phone Number
*Facsimile Number
*Account Number

Bank Reference Information
*Bank Name *Contact Name
*Address
*City *State   *Zip 
*Phone Number *Facsimile Number
*Account Number

Horizon Logistics would like to provide you with an answer as quickly as possible to your request for credit and to assist us in doing so, we ask that you supply us with complete and accurate information. All information is subject to verification. Based on the information you provide in this application, your payment history and information contained in your credit report please allow up to four (4) weeks for processing.

By selecting Next you are agreeing to the user Terms and Conditions of this Credit Agreement