Credit Request

For Transportation and Related Charges

Thank you for your interest in USA Truck, Inc.  In order to extend credit to you, we would like to make sure that we have all the neccesary information. Please complete this form. If you have any questions, please e-mail the Credit Department.

BUSINESS INFORMATION
Legal Business Name: *
Physical Address
Address Line 1: *
Address Line 2:
City: *
State: *
Zip Code: *
Phone #: * ()--
FAX #: * ()--
Dun & Bradstreet Number: *

BILLING INFORMATION ( If Different From Above )
Name:
ATTN:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Phone #: )--
FAX #: )--

ACCOUNTS PAYABLE CONTACT INFORMATION
First Name: *
Last Name: *
E-Mail
Phone #: * ()--
Name of Principals: *
Principals Phone #: * ()--
Name of Bank: *
Bank Phone #: * ()--

FREIGHT CARRIER REFERENCES ( Please List 3 )
Reference 1 Name: *
Reference 1 Phone #: * ()--
Reference 2 Name: *
Reference 2 Phone #: * ()--
Reference 3 Name: *
Reference 3 Phone #: * ()--

CURRENT FINANCIAL INFORMATION
Financial statements will be of great assistance to us in establishing a credit limit for you. Please mail or fax any pertinent financial statements to USA Truck, Inc. with the completed and signed application.

BILLING REQUIREMENTS
Please list any special billing requirements you may have regarding payment of freight bills or any additional comments that you believe will aid in the processing of this request.

DISCLAIMER
We certify that all of the information on this form is correct and that we fully understand the credit terms that all freight charges are due 15 days from receipt of freight bill.  We agree to pay accordingly in consideration of extended credit.
* Required information