Midway Distribution, Inc. Credit Application

We would like to become your logistics partner, but first we need information about your company.

Invoices are dated and mailed the day of pickup. Please provide any information you will need on the invoice upon booking the order. If you use Control Numbers, Bill of Lading Numbers, Purchase Order Numbers, etc, please let us know so that we may include this information on the invoice for you.

Applicant agrees all invoices are due 15 days from date of invoice. Applicant further agrees all costs associated with the collection of freight charges are the responsibility of the applicant.

Midway Distribution, Inc. Credit Application Form

Control Number Description :     Company Name :     Billing Address :     Email Address :       Type of Business : Sic Code Date Established : ex. 00/00/00 No. Employees Accounts Payable Contact :     Phone No. :     Fax No. :       Bank Name :     Bank Address :     City ;     State : Choose a State Alabama Alaska Alberta Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Bank Contact :     Bank Phone :       References :       1. Phone : 2. Phone : 3. Phone : 4. Phone :         Completed by : Date :