Financing

 
BEE LINE TRANSPORT
CREDIT APPLICATION
Name of Business:*
Street Address:
Address Line 1
Address Line 2
 
City
 
State
 
Zip
 
Billing Address (if different from above):
Address Line 1
Address Line 2
 
City
 
State
 
Zip
 
Phone:*
Fax:
Email*
Type of Business:*
 
 
 
 
 
 
Incorporated in what state:
Number of years in business:*
PRINCIPAL BUSINESS OFFICER (owner/partners/officers)
Name:
Title:
Address
Address Line 1
Address Line 2
 
City
 
State
 
Zip
 
Phone:
Name:
Title:
Address Line 1
Address Line 2
 
City
 
State
 
Zip
 
Phone:
BANK REFERENCE
Address
Address Line 1
Address Line 2
 
City
 
State
 
Zip
 
Contact:*
Phone:*
Contact:*
Phone Number.*
Address
Address Line 1
Address Line 2
 
City
 
State
 
Zip
 
2. Company Name:*
Contact:*
Phone Number.*
Address
Address Line 1
Address Line 2
 
City
 
State
 
Zip
 
3. Company Name:*
Contact:*
Phone Number.*
Address
Address Line 1
Address Line 2
 
City
 
State
 
Zip
 
Are Purchase Order Numbers required for your business?*
 
 
 
 
Is your business exempt from Virginia Sales & Use Tax?*
 
 
 
 
(if so, please send to btl@beelinetransportinc.com, VA ST-10, Sales & Use Tax Exemption Certificate)
Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter. I fully understand your credit terms are due payable by the 30th of the month following purchase. I also understand that a FINANCE CHARGE of 2% per month may apply to all balances over thirty days past due. Reasonable collection and attorney costs may be added when required.

Date*
All references listed are hereby requested to release information required to process this information.