Account Request Form

Feel free to submit this directly or to print and fax (800-795-9USA) or mail to 15 Court Square #400, Boston, MA 02108

Opening an account gives you online ordering, tracking and reporting features for all your delivery needs.

We want to be your courier service solution.

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The undersigned company is applying for credit with USA Couriers, Inc, for courier services and agrees to abide by the standard terms and conditions of USA Courier, Inc. as printed below.

USA Couriers Credit Application

The undersigned company is applying for credit with, services by and agrees to abide by the standard terms and conditions of USA Couriers, Inc. as printed below. * ITEMS ARE REQUIRED.

Company Name Dun and Bradstreet #

DBA (if different) *Phone

*Contact Person *Email Fax

*Physical Address *City *State

*Zip Code *Company Website URL

Federal Tax ID# Year business established

*Are you a State of Incorporation

Names, titles and addresses of your three chief corporate officers or partners

*Officer 1

Officer 2

Officer 3

TRADE REFERENCES

*Reference #1 *Contact Name

Complete Address *Phone or Email

Reference#2 Contact Name

Complete Address Phone or Email

*Reference or Purchase order Required? Yes No

Accounts Payable Information

*A/P Contact *Phone * Email

*Complete Mailing Address

Special Instructions

Representations *I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself.

Terms* 1. Bills are sent on the first day of each month. All Same Day delivery bills are payable within 30 days of invoice and if not paid by the within that time period are considered past due. 2. All Overnight Delivery bills are payable within 15 days of invoice and if not paid by the within that time period are considered past due. 3. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.

Authorized Signature* *Printed Name *Title *Date