* - Required fields

Please provide the following Company Information:

* Your Name:			* Your DBA Salesperson:
* Your Title:
* Business Name:
D / B / A:
* Street Address:
Address(cont.):		*State	*ZipCode	*Country
City:
* Work Phone:
Fax:					*Date Established
* Email:
Website:		DUNS #	*Tax ID or SSN	*Type of Business	*For Past Years
				Corporation Partnership Proprietership Franchise

Please provide the following Principal/Ownership Information:

	Principal # 1		Principal # 2
* Name:		Name:
Title:		Title:
* SSN:		SSN:
* Home Address:		Home Address:
* City:		City:
* State/Province:		State/Province:
* Zip/Postal Code:		Zip/Postal Code:
Country:		Country:
Phone:		Phone:

Please provide the following Trade References information (Include transportation carriers):

	Trade Reference # 1		Trade Reference # 2
* Name:		* Name:
* Street Address:		* Street Address:
* City:		* City:
* State/Province:		* State/Province:
*Zip/Postal Code:		* Zip/Postal Code:
Country:		Country:
Phone:		Phone:

	Trade Reference # 3		Trade Reference # 4
* Name:		* Name:
* Street Address:		* Street Address:
* City:		* City:
* State/Province:		* State/Province:
*Zip/Postal Code:		* Zip/Postal Code:
Country:		Country:
Phone:		Phone:

Please provide the following Bank References information:

	Bank Reference # 1		Bank Reference # 2
* Bank Name:		* Bank Name:
* Account #:		* Account #:
Contact:		Contact:
* Street Address:		* Street Address:
* Address(cont.):		* Address(cont.):
* City:		* City:
* State/Province:		* State/Province:
* Zip/Postal Code		* Zip/Postal Code:
Country:		Country:
Phone:		Phone:
* Appx Balance:		* Appx Balance:
*Type of Account:		* Type of Account:

Type of Credit Agreement:

Customer agrees to Credit Terms  --  Net 30 Days from date of Invoice.

Outstanding balances are subject to 1.5% per month interest from the original due date.

Applicant agrees to pay any collection costs incurred to collect the account balance including court costs, collection fees, and attorney's fees up to and including 33% of the amount outstanding.

The undersigned authorizes and releases all banks, businesses, and persons identified on this application to furnish any and all information requested by Distribution by Air or its representative by telephone or written correspondence.

The undersigned warrants that the information provided on this application is true and correct.