Credit Application


 
*RED is Required
Firm Name: Phone:
Street Address:
City/State/Zip:
Billing Address:
Use company for billing address
City/State/Zip:
Shipping Address:
Use company for shipping address
City/State/Zip:
AP Contact:Phone:
AP Email: 
 
Invoices and Statements will be emailed to the above address.
 
Paper copies are not available.
Type of Business:
How Long in Business:
Number of Employees:
Bank Name: Phone:
Street Address: Fax:
City/State/Zip:
Contact:
 

Trade References

Name: Phone:
Street Address: Email:
City/State/Zip:
Name: Phone:
Street Address: Email:
City/State/Zip:
Name: Phone:
Street Address: Email:
City/State/Zip:
 
Primary Account User:
 
Individual wishing to receive all freight, scheduling, confirmation, and billing emails (Parts Manager, Shipping Manager, etc.)
Authorized Signature Email:
Authorized Signature Phone:
 
I hereby authorize Freight Buddy to receive full information as requested, relating to our credit and bank experiences.
 

Freight Buddy is a registered trademark of Reviva Logistics, Inc. 3/12.