General Information

    *Legal company name:

    *Email address:

    *Address:

    *City:

    *Province/ State:

    Postal code/ Zip:

    Telephone:

    Fax:

    Website:

    Custom broker (Export):

    Customs broker (Import):

    Nature of business:

    C-TPAT SVI#:

    Number of years in business?

    Credit amount required per month?

    Type:FranchiseProprietorshipPartnershipLimited company

    AP Contact Information

    Name

    Phone:

    Email:

    Principles

    Name #1

    Title #1

    Name #2

    Title #2

    List other affiliated companies:

    Banking Information

    Name of bank and location:

    Bank telephone

    Account number:

    Credit References

    Reference #1

    Company name:

    City:

    Contact name:

    Telephone number:

    Reference #2

    Company name:

    City:

    Contact name:

    Telephone number:

    Reference #3

    Company name:

    City:

    Contact name:

    Telephone number:

    Please note: The applicant is aware and fully understands that: a) Freight charges are due upon receipt of GX’s invoice and are past due 21 days thereafter.b) Past Due accounts are subject to cancellation and subsequent to third party collection action. c) All freight Charges must be paid before any claims can be processed. Shipper assumes full liability of all charges incurred including interest 2% per month (24% per per annum) if consignee refuses to pay charges on “collect” shipments.

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    GX Transport sales representative:

    Please review our Terms and Conditions

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