Iron Castle Expeditor
New Customer Request Form
Please Copy and Return
Phone: 734-748-9575
Fax: 734-464-4358
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New Customer Request Form
Business Information
*Company/Account Name__________________________________________________
*Contact Full Name____________________*Contact Title________________________
*Address, Suite/Dept.____________________________ *City_____________________
*State____________ *Zip Code_____________________
*Phone Number (____) ______-______________ Fax Number (____) _____-_______________
Billing Information
*Company/Account Name______________________________________________________
*Contact Full Name_______________________ *E-Mail Address_____________________
*Address, Suite/Dept.___________________________ *City__________________________
*State_______________________ Zip Code_____________
*Phone Number (____) _____-________ Fax Number (____) _____-________
User Information
*Your Full Name___________________________ *Phone Number (_____)______-________
*User ID#___________________________ *E-Mail Address___________________________
Additional Business Information
*Business Type______________________________ Year Established_____________________
*Federal/Tax ID____________________________ Duns Number________________________
(Please enter your federal/tax id #. This is required for new business account.)
Payment Information
We accept all of the major credit cards:
Credit Card Type [MC] ___ [Visa] ___ [AMX] ___ (Please check one.)
This application will also serve as an authorization to release information from your bank to Iron Castle Expeditor LLC, and any creditors who may need authorization from you, the customer. This information contained herein is confidential and is only supplied to the company for which you are applying credit. This also authorizes companies to FAX back their reply to us.
*By submitting this form you agree to accept the Terms & Conditions of Iron Castle Expeditor LLC
Please List Three Companies that you have business accounts with.
Company____________________________Contact_______________________Phone (____) _____-_______
Company____________________________Contact_______________________Phone (____) _____-_______
Company____________________________Contact_______________________Phone (____) _____-_______
TERMS AND CONDITIONS
The applicant(s) executing this application and agreement (*customer) hereby agree(s) that the payment for all services is subject to the following terms and conditions:
1. Customer Agrees that all amounts due for services provided by Iron Castle Expeditor LLC are payable to 7344 Cheyenne, Westland, MI 48185.
2. Customer agrees that all amounts due are not payable in installments, but are Payable At Pick-up or NET 7 days upon receipt of invoice. Company reserves the right to demand payment of all outstanding past due freight charges as a pre-condition for releasing any shipment(s) at destination. This right includes the right to demand payment upon delivery of any shipment(s) at any time. If any Invoices unpaid after 30 days will be considered past due and subject to a 2% per month charge. Iron Castle Expeditor reserves the right to increase or decrease credit limits or cancel credit totally.
3. In the event that the account becomes delinquent and is turned over for collections, customer agrees to pay all reasonable attorneys' and collectors' fees, plus all attendant collections/court costs.
4. Customer agrees to notify the company by certified mail of any changes of ownership of customer and further agrees to be liable for all losses incurred as a result of failure to comply with said modifications.
5. Customer authorizes the company and/or its credit agency(s) to investigate all credit history, bank references and any other information required to process this application and as it deems necessary in the future.
6. Applicant's signature attests to the financial responsibility, ability and willingness to pay creditor's invoices in accordance the creditors terms stated above and may be adjusted from time to time in writing by creditor.
Owner/Officer Signature (required): ________________________________________________________________
Print Name ________________________________ Title _________________________ Date__________________
Iron Castle Expeditor LLC All Rights Reserved 2007 New Customer Request Form