Home
Clients
Tracking
Carriers
Quote
About
Contact
Careers
Privacy
Home
Clients
Tracking
Carriers
Quote
About
Contact
Careers
Privacy
CREDIT APPLICATION
COMPANY CONTACT INFORMATION
Company Name
DBA
Street Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
NL
PE
NS
NB
QC
ON
MB
SK
AB
BC
YT
NT
NU
Zip Code
Phone
Billing Address (if different than above)
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
NL
PE
NS
NB
QC
ON
MB
SK
AB
BC
YT
NT
NU
Zip Code
Shipping Contact Name
Shipping Contact Email
Credit Amount Requested
+
-
ACCOUNTS PAYABLE NFORMATION
AP Contact Name
Title
AP Contact Phone
AP Email
Billing Requirements
BOL Required
POD Required
Billing Reference Number Required
COMPANY TYPE & STRUCTURE
How is Company Organized?
Sole Proprietorship
Partnership
Limited Liability Company
Corporation
Date of Establishment
Federal Tax ID Number
Annual Gross Revenue
Principal(s) Name & Title
Bank Reference
Trade Reference
Trade Reference
Payment for all freight bills is to be received at Reliance Global Logistics 255 Farmington Rd Summerville, SC 29483 ("Reliance") WITHIN 30 DAYS OF INVOICE DATE. Accounts which are 31 days old will beconsidered delinquent and subject to review of credit privilege. A service charge of one and one-half percent monthly (1 ½ % monthly) may be assessed on all bills 31 days old or older. If collection is made by lawsuit or otherwise, I/We agree to pay all collection costs including reasonable attorney's fees and hereby waive all rights to claim exemption under state laws. If you require a special number to be listed onthe invoice for your reference please refer to the above section titled "Accounts Payable Information." I/We will not deduct from any freight bills regardless of exempt status for claims issues. Claims will betreated separately and claims forms will be filed, with no right of deduction or offset of Reliance invoices. I/We agree that all disputes with Reliance will be subject to jurisdiction and resolution in Dorchester County, South Carolina. The terms and claims sections of this agreement supersede any other contract and/or agreement referencing payment terms or claims with Reliance, and I/we expressly agree thatadditional terms and conditions listed at the following location are incorporated into this agreement. I/We have read this credit policy and agree to abide by its terms which can be found at www.reliancelog.com/tc
I agree to Reliance Global Logistics' Shipper Terms and Conditions
Date of Signed Agreement
Authorized E-Signature (Type Name)
Title
Email
Phone
Please enter the code:
Our
Privacy Policy
applies.
Note:
Please fill out the fields marked with an asterisk.