To
apply for credit with Republic Shipping Consolidators
Inc., please complete the following application. When
you click the "Submit Form" button at the end of the
form, the information you enter will be sent to the
Republic Shipping Consolidators Credit and Collections
department for review.
Note: The form will not work with some browsers (e.g.,
AOL).
If a blank email form displays when you click the
"Submit Form"
button, please call the Credit and Collections
Department at
(305) 594-7124 to find out how to apply.
If you prefer to print and fax, please call us.
( Please fill out this form completely)
Full
Name of Company
Billing
Address
City
State/Postal Code
Physical
address
City
State/Postal Code
Phone
Number
Fax
Company
President
Controller
Accounts
Payable Contact
Fed-ID#
Type of
Business
Other:
Parent
Company
Branches
Has
ownership changed
in the last year?
Years in
business
Freight
payment schedule NET
Are you
on schedule with your
payments now?
Fax
notification to
Fax
options
Industry Type
Other:
BANK INFORMATION
This
application will also serve as an authorization to
release a reference from your bank to Republic
Shipping Consolidators, and any creditors who may
need an authorization from you, the customer. The
information contained herein is confidential and is only
supplied to the company for which you are applying for
credit. This also authorizes companies to FAX back
their reply to us.
Bank
Name
Account Number
Contact
Phone
Line of
Credit Acct. # (If applicable)
Account Number
Name of
Company Officer Approving
Title
of Company Officer Approving
REFERENCES
Please
list four References, two of which MUST be
carriers.
Reference One
Company Name
Contact Person
City
State
Phone
Fax
Reference Two
Company
Name
Contact
Person
City
State
Phone
Fax
Reference Three
Company
Name
Contact
Person
City
State
Phone
Fax
Reference Four
Company Name
Contact Person
City
State
Phone
Fax
TERMS AND CONDITIONS
The
applicant(s) executing this Application and Agreement
("Customer") hereby agree(s) that payment for all
services is subject to the following terms and
conditions:
1.
Customer agrees that all amounts due for services
provided by Republic Shipping Consolidators Inc.
and/or any of its affiliates.
2.
Customer agrees that all amounts due are not payable
in installments, but are payable Net 30 days
from date of invoice. Company reserves the right to
demand payment of all outstanding and past due
freight charges as a pre-condition for releasing any
shipment(s) at destination. This right includes
the right to demand payment upon delivery of any
shipment(s) at any time. If any amount is not paid
within said period a delinquency charge of 1.5% per
month of the delinquent balance shall be added to
the sum due.
3.
In
the event the Account becomes delinquent and is
turned over for collection, Customer agrees to pay
all costs of collection including reasonable
attorney fees and court costs.
4.
Customer agrees to notify the Company by certified
mail of any changes in ownership of Customer and
further agrees to be liable for all losses incurred
as a result of failure to comply with said
notifications.
5.
Customer authorizes the Company and/or its Credit
Agency(s) to investigate all credit history, bank
references and any other information required to
process this application and as it deems necessary
in the future.
Date
(mm/dd/yyyy)
Officer,
Owner or Partner
Title
Email
If
printed and submitted by mail SEND TO: Republic Shipping Consolidators Inc.
