Credit Application Form

The answers in this form will serve as basis for your credit application with Enhanced Logistics 21. Therefore please provide complete and accurate information.

All information with a * is mandatory

...Please tell us what you are looking for...

What services and/or product(s) are you interested in?

...Please tell us about your company...

Company Trade Name

Company Website

Company Legal Name

Company Tax ID Number

Have you ever done business or have existing accounts with Enhanced Logistics 21 or any of it's affiliates?

Yes No

New Owner?

Yes No

New Business?

Yes No

Foundation date (Year)

Number of Employees

Annual Revenues in $

Annual Profit/Loss in $

Building Facilities

Owned Leased

If leased, please mention Owner's name

Mobile number

Please share with us at least one reference you work with:

Business name

Contact person

Title

Mobile number

Business name

Contact person

Title

Mobile number

Business name

Contact person

Title

Mobile number

...Please share with us your contact information...

Billing Address

Postal Code

City

Country

Shipping Address

Postal Code

City

Country

Main Contact Person

Title

Mobile number

Finance Contact Person

Fax

Mobile number

Please provide the following information for all Individual Proprietors (>25% ownership), Majority Owners, General Partners or Corporate Officers

Contact Person 1

Title

Ownership %

Mobile number

Address

Postal Code

City

Country

Driver's Licence No

Contact Person 2

Title

Ownership %

Mobile number

Address

Postal Code

City

Country

Driver's Licence No

Contact Person 3

Title

Ownership %

Mobile number

Address

Postal Code

City

Country

Driver's Licence No

...Please share with us who your bank is...

Bank Name

Bank Account Number

Address

Postal code

City

Country

Loan Officer Contact Person

Mobile Number

...Anything else you want to share with us?...

Are the applicant(s) party to any pending litigation or legal proceedings?

Yes No

* Click here to indicate that you have read and agree to the following terms and conditions and that you have the authority to enter into the credit application terms and conditions.

First Name

Last Name

Title