Credit Request


Looking to add a quality carrier to your team? Fill out our online Credit Request form and submit it. One of our team members will review the request and get back with you.

All fields marked with an * are required.

Terminal *  

Business Information

Business Name *  
Address 1 *  
Address 2
City *  
State *  
Zip *    
Web Site
Phone *    
Fax  
Nature of Business
Tax ID *  
MC Number
Date Established *    
Type of Business *  

Bank Information

Bank Name *  
Address 1 *  
Address 2
City *  
State *  
Zip *    
Phone *    
Bank Account No.
Account Type *  
Bank Contact

Trucking / Trade References You must provide at least 3 references.

Reference #1Reference #2Reference #3
Reference Name *  
Address 1 *  
Address 2
City *  
State *  
Zip *    
Email Address  
Phone *    
Fax  

Conditions of Sale and Terms of Payment

In consideration for any extension of credit, Purchaser agrees to the terms herof and to the conditions of sale set forth on each invoice. Purchaser also agrees to pay a service charge of one and one-half (1 1/2) percent per month (or the maximum allowable contract rate under state statures) computed on the unpaid deliquent balance until the account is paid in full. The purchaser also agrees to pay reasonable attorney fees and other costs incurred for collection.


*  
Your Name *  
Phone *     		Your Email  
Your Title *  

By submitting this form, you are stating that all information entered in this form is true and accurate and that you have authorization as a representative within your company to proivde this information to us. All information received is confidential and will not be sold or distributed to any persons or businesses outside of Clark Freight Lines Inc.



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