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  Credit Application
Contact Information
*Legal Name of Business:
DBA Name:
*Address:
*Country:
*Zip, City, State:
, City Lookup
*Email:
Date of Incorporation:
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State of Incorporation:
Officer Name & Title:
A/P Contact:
Phone:    Ext:
Fax:
*AAA Cooper Transportation Sales Territory Manager:
Freight Billing Address    
*Company:
*Address:
*Country:
*Zip, City, State:
, City Lookup
Contact:
Phone:    Ext:
Fax:
Other Information
Type of Business:
Years in Business:
No. of Employees:
Annual Revenue:
Expected Monthly Dollar Amount:
Federal ID #:
D & B #:
Bank Institution:
Have you Previously established Credit with AAA Cooper Transportation?
Month/Year:    Location:
*Application for following AAA Cooper Service(s):
Invoicing Method
*Invoicing Options (please mark one):

*Invoicing Frequency (please mark one):

*Email Address(es) for Invoice Delivery: (separated by semicolon)

Credit References
List three companies, other than credit card companies and financial institutions, with whom you have established credit
*Company Name    *Zip            *City               *State *Account # *Phone # *Fax #
, City Lookup
, City Lookup
, City Lookup

*

 

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