AJC Logistics Credit App · PDF fileAJC Logistics New Customer Form ... Account Name: AJC...

AJC Logistics LLC DBA Eagle Logistics Systems

1000 Abernathy Road NE, Suite 600 Atlanta, Georgia 30328

Tel: 404-942-1402, Fax: 404-942-1502

AJC Logistics New Customer Form (NCF) 2014

New Customer Form

Instructions: All information must be complete and return to AJC Logistics LLC Credit Department via fax.

Company Information (REQUIRED)

Official Business Name _______________________________________________________________________

Delivery Address_____________________________________________________________________________ Phone # (_____) _________________________________Fax# (_____) ________________________________

E-mail :____________________________ Web Site: _______________________________________________

Years in Business ___________ Type of Business _________________________________________

Form of the Business (Check One):

Sole Owner ________ Partnership________ S Corporation _______ C Corporation ________ LLC __________

Subsidiary Corporation ____________ If Subsidiary Corporation, please provide Parent Corporation Information:

Name______________________________________________________________________________________

Address____________________________________________________________________________________

If Corporation, year of Incorporation__________________ State of Incorporation _________________________

(REQUIRED ALONG WITH SIGNED W9 FORM) Federal Tax ID Number /Social Security Number (If individual):

__________________________________________________________________________________________

Owner/Partners/Stockholders/Officers of Company: Name_______________________________________ Title_________________________________________

Phone#_(_____)_______________________________ Fax#_(_____)_________________________________

Name_______________________________________ Title_________________________________________

Phone#_(_____)_______________________________ Fax#_(_____)_________________________________

Trade References

Please Provide THREE Business References (Preferably Product Suppliers)

Company Name_________________________________________________________________________________

Mailing address: ________________________________________________________________________________ City _____________________ State ____________________ Zip Code _____________________

Phone#_(_____)_________________ Fax#___(_____)_____________ E-mail _________________________

Company Name_________________________________________________________________________________


Phone#_(_____)_________________ Fax#___(_____)_____________ E-mail _________________________

Company Name_________________________________________________________________________________


Phone#_(_____)_________________ Fax#___(_____)_____________ E-mail _________________________



Tel: 404-942-1402, Fax: 404-942-1502


Bank References Name________________________________________ Phone#_(_____)__________________________________ Address______________________________________ Fax#___(_____)__________________________________ Account Number_______________________________ Bank Officer/Contact_______________________________

Billing Information: ACCOUNTS PAYABLE EMAIL address for invoices AND Invoice Instructions if Applicable (Required): _________________________________________________________________________________________________

Accounts Payable Contact (Required):

Name_______________________________________ Title_____________________________________________

Phone#_(_____)_______________________________ Fax#_(_____)_____________________________________

AJC LOGISTICS reserves the right to:

1. Withdraw credit privileges should the account not be maintained according to credit terms. 2. Request an additional payment should a credit limit be exceeded. Request a cash in advance payment prior to any

orders being accepted. 3. Refuse credit privileges if deemed necessary.

Credit terms are Net 30 days unless otherwise specified in writing and signed by an officer of AJC Logistics, LLC. This agreement shall be governed under the laws of the State of Florida. Any action brought under this Agreement or involving in any manner whatsoever the relationship AJC Logistics and Applicant shall be determined under Florida law. Applicant hereby consents to submit to jurisdiction of the state or federal courts of the State of Florida and agrees that such Courts within Duval County, State of Florida, shall have original exclusive jurisdiction over all matters and all disputes between the parties hereto regardless of the origin of such disputes and agrees that personal jurisdiction shall reside with such courts for purposes of any action or proceeding on or related an agreement between AJC Logistics and Applicant. Should Applicant be a corporation or other business entity, the signatories hereto personally guarantee, affirm, and assure that they have authority to bind such business entity. Declaration: I/We hereby confirm that to the best of my/our knowledge the above statements are true. I/We make this application to open an account with AJC Logistics LLC and indicate my permission to obtain credit information from the sources referenced. I/We understand that credit terms are Net 30 Days upon receipt of invoice. I/We confirm financial responsibility and willingness to pay invoices in accordance with terms. I/we further agree to pay all legal and collection costs, to include court costs, attorneys fees and interest at the rate of 1-1/2% per month, incurred by AJC Logistics to collect all amounts due which become in default of the terms of the credit extended. Authorized Signature of Applicant : Name (Please Print): _______________________________________________ _______________________________________________ Title____________________________________________ Date___________________________________________



Tel: 404-942-1402, Fax: 404-942-1502


PAYMENT INFORMATION FOR CASH IN ADVANCE ACCOUNTS – ONLY WIRE OR CERTIFIED CHECKS ARE ACCEPTED WIRE ROUTING INSTRUCTIONS Account Number: 1313 - 729 784 Routing (#): 011500120 Account Name: AJC Logistics Bank Name: RBS Citizens, NA Bank Address: 1 Citizens Plaza, Riverside, RI 02903 Swift Code: CTZIUS33 CERTIFIED CHECKS SHOULD BE SENT OVERNIGHT TO: AJC LOGISTICS 1000 ABERNATHY ROAD SUITE 300 ATTN: LADY PARADA/CREDIT ATLANTA, GA 30328 OTHER PAYMENT OPTIONS: ACH ROUTING INSTRUCTIONS Account Number: 1313 - 729 784 Routing (#): 211070175 Account Name: AJC Logistics Routing (#): RBS Citizens, NA Bank Address: 1 Citizens Plaza, Riverside, RI 02903 MAILING ADDRESS FOR REGULAR CHECKS: AJC LOGISTICS PO BOX 347422 PITTSBURGH, PA 15251



Tel: 404-942-1402, Fax: 404-942-1502


AJC Logistics Credit App · PDF fileAJC Logistics New Customer Form ... Account Name: AJC...

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