CREDIT REFERENCES

All information is needed to send this form.

Company Name :

Company Address :

City : State : Zip :

Phone Number : Fax Number :

Contact for Accounts Payable :

Accounts Payable Fax # :

Accounts Payable Email :

Bank :
Contact person:
Bank Phone Number :
Account Number :

Three Trade References

1. Name : Phone :
Address :

2. Name : Phone :
Address :

3. Name : Phone :
Address :

All charges are due and payable from 30 days from date of invoice. Outstanding amounts beyond 30 days will be considered delinquent and credit priviledges will be subject to suspension. Late payments may be subject to penalty charges, not to exceed 1.5% per month. An extra 2% discount may be taken, if invoice is paid within 15 days.

BY SUBMITTING THIS FORM, YOUR COMPANY IS ENSURING THAT PRESIDENTIAL EXPRESS WILL BE REIMBURSED FOR ALL LOADING AND/OR DEMURRAGE CHARGES THAT THEY OUTLAY.

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