Form - Account application

In order to streamline your administration, we believe it would be beneficial to open an account with Mexuscan Cargo, rather than billing you for each pickup or delivery individually. Please complete the brief questionnaire below. We will then invoice you at regular intervals, and our credit policy stipulates payment within 30 days from the statement date.

"*" indicates required fields

Company Name*

Address

City

Postal Code

Phone*

Fax

Owner(s) Name(s)

In Business Since

Industry

Accounts Payable Contact Person

Email Address

Payment Terms

30 days

Name of Your Financial Institution

Branch

Account Number

Phone

Account Manager

I authorize Mexuscan Cargo to obtain, from any person it deems appropriate, all information it deems necessary regarding this account opening request. This authorization constitutes the consent required by any law concerning the protection of personal information.

Last Name

Title

Date

Please name four primary suppliers (excluding fuel, credit cards, electricity, phone, and others).

Supplier 1

Last Name

Address

City

Postal Code

Phone

Fax

Email Address

Supplier 2

Last Name

Address

City

Postal Code

Phone

Fax

Email Address

Supplier 3

Last Name

Address

City

Postal Code

Phone

Fax

Email Address