New Account Application

Business Information:
Company Name:
DBA (if applicable)

Company address:
City:
State:

SELECT STATE ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT D.C. DELAWARE FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW MEXICO NEW YORK NEW JERSEY NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

ZIP Code:

Phone: Fax:
Email Address:

Federal ID Number: Business Type Sole Proprietorship Partnership Limited Liability Company Limited Partnership Corporation Other

Start Time
End Time

COMPANY CONTACTS

Owner(s)
President:
Controller:
Accounts Payable:

BILLING ADDRESS IF DIFFERENT FROM ABOVE

Billing address:
City:
State:

SELECT STATE ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT D.C. DELAWARE FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW MEXICO NEW YORK NEW JERSEY NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

ZIP Code:

Do you use courier services on a regular bases? Yes No
If Yes. How many times per week?

Credit Amount Requested?
What are your companies normal payment terms?

AGREEMENT

By my submission below, I hereby certify that the information in this account application is true and correct.  The information provided herein is confidential and is solely for the use of Cleveland Delivery Service, LLC to set up account information in our systems for ordering and billing.      

Also by my submission below, I agree to the current terms and conditions of payment for services rendered by
Cleveland Delivery Service, LLC.

Terms are Net in 10 days upon receipt of invoice; to be paid in full and payable to Cleveland Delivery Service, LLC
Past due invoices will be subject to 1.5% service charge for every 30 days past due.

Name of Submitter
Title:  Date: