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Customer Credit Application
Please complete and submit the information below.  We will evaluate your request and contact you.
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CUSTOMER INFORMATION:
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CREDIT REFERENCES: List (3) - Preferably Transportation Creditors:
BILLING INFORMATION:
Billing Inclusions and Attachments
*Information - Check the appropriate box if this information must appear on the Invoice. 
*Attachments - Check the appropriate box if this information must appear on the Invoice. 
If you selected "other" for Information that needs to appear on invoice please explain what else you would like to be included.
If you selected "other" for Attachments that needs to appear on invoice please explain what else you would like to be attached.
Email Billing / Green Initiative
Our preferred method of billing is through use of email. This allows us to send statements which list each of the invoices as well as links that will pull up scanned images of the invoices and supporting documentation. In addition, we have the ability to issue logins for our customers into our website which gives them access to this information whenever they need it.
Mailing Instructions (if unable to accept billing via email)
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This information is given to obtain an open account status. The person submitting this application/executing this agreement agrees that the company he/she represents will make full payment to QUANTUM LOGISTICS, LLC. (henceforth QUANTUM LOGISTICS) upon receipt of invoice, but in no case later than thirty (30) days following date of invoice. By submitting this form, permission is granted to QUANTUM LOGISTICS to inquire about this company's credit worthiness from any source. The person submitting this application/executing this agreement agrees that the company he/she represents will pay all collections/attorney's fees if this account is placed for collection. The person submitting this application/executing this agreement agrees that the company he/she represents must notify QUANTUM LOGISTICS in writing, and by certified mail of any change in ownership, the name, or the business structure under which credit is established.  The person submitting this application/executing this agreement has authority to bind the company he/she represents and is authorized by that company to enter into the credit application process and are subject to QUANTUM LOGISTICS Terms and Conditions. The person submitting this application/executing this agreement acknowledges that entering his/her name into the "E-Signature" field is equally binding as a physical signature and will be liable as such. The person submitting this application/executing this agreement certifies that the above information is as complete, accurate, and true to the best of his/her knowledge.

The purpose of this form is to gather information which will help our companies work together smoothly through the billing and collection process. Please do not hesitate to contact us if there is anything we can do to better serve you.
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Please review the entire form to ensure it is complete and use the "Submit" button below to submit this

Online Credit Application.

Your Submission Was Successful!

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