| DISTRIBUTION BY AIR, INC. |
| a DBA Distribution Services, Inc. Company |
| P.O. Box 6090, Somerset, NJ 08875 Tel: 888-588-1011 Fax: 732-764-6783 |
| Account Profile |
Please Print and Fax this Form along with the Credit Application to 732-764-6783
|
Customer Information |
| Company Name: ____________________________________________________ |
| Address: __________________________________________________________ |
| City:_____________________ State: _____________ Zip Code: ____________ |
| Primary Contact: _____________ Title: _______________ Phone: _____________ Ext:______ |
| Other Contact: _______________ Title: _______________ Phone: _____________ Ext:______ |
| After Hours Contact: _____________________ Phone: _______________________ Ext: ______ |
| After Hours Pager: ______________________ Phone: ________________________ Ext: ______ |
| E-Mail Address:________________________ How much credit do you require? $___________ |
| Commodity Shipped: __________________________ Is your business seasonal? [ ] Yes [ ] No |
| Type of Shipments? [ ] Domestic [ ] International [ ] International Air [ ] Ocean |
| Accounting Information |
| Accounts Payable Address (If Different from Pick-Up Address) |
|
|
| Company Name: ____________________________________________________ |
| Address: __________________________________________________________ |
| City:_____________________ State: _____________ Zip Code: ____________ |
| Primary Contact: _____________ Title: _______________ Phone: _____________ Ext:______ |
| If you use a Freight Payment Plan, Specify Name, Address & Account # Below: |
| ___________________________________________________________________________________________ |
| Does Accounting require P.O.#'s ? [ ] Yes [ ] No |
| Do you Operate on G.B.L's ? [ ] Yes [ ] No |
| Does Accounting Require Original B.O.L ? [ ] Yes [ ] No |
| Special Instructions: _____________________________________________________________ |
| _______________________________________________________________________________ |
| Your Name: | ______________________________________________________ | Title: | ______________________________________________________ |
|
Date: |
______________________________________________________ |
| Terminal: _______________________ Sales ID: ________________________ |
|
Please Print and Fax this Form along with the Credit Application to 732-764-6783 |