Maverick Transportation / Credit Application

All starred fields must be completed to insure correct processing of your application.

Company Information

Company *

Contact Name *

Billing Address *

Billing City *

Billing State *

Billing ZIP *

Special Billing Requirements *

Auto Pay
EDI
Fax

Paperwork Requirements *

Accounts Payable Contact *

Accounts Payable Primary # *

Accounts Payable Fax # *

Accounts Payable Email Address *

Carrier Reference Information

Carrier Reference *

Carrier Contact *

Carrier Phone # *

Carrier Address *

Carrier City *

Carrier State *

Carrier ZIP *

Company Reference Information

Company Reference *

Company Contact *

Company Phone # *

Company Address *

Company City *

Company State *

Company ZIP *

Company Reference 2 Information

Company 2 Reference

Company 2 Contact

Company 2 Phone #

Company 2 Address

Company 2 City

Company 2 State

Company 2 ZIP

Bank Reference

Bank Reference *

Bank Contact *

Bank Contact Phone # *

Federal ID

Federal ID *

PLEASE READ CAREFULLY BEFORE SUBMITTING

I certify that I have read the terms and conditions printed above *

CREDIT APPLICATION