NEW ACCOUNT APPLICATION FORM

 

 

Kindly fill out all the information in our form. Print and fax it back to Prime Time Courier @ 780-447-3735.

 

Legal name of business:___________________________________

 

Mailing address:_________________________________________

 

City & postal code:_______________________________________

 

Contact name to guarantee payment:_______________________

 

Phone number accounts payable:___________________________

 

Fax number accounts payable:_____________________________

 

We require a credit card number to guarantee payment. The credit card will not be used unless your account goes over 90 days.

 

Name on card:_ _________________________________________

 

Card number:___________________________________________

 

Expiry date:____________________________________________

 

I authorize Prime Time Courier to use my credit card for payment if my account is not paid within90 days of the billing date.

 

X________________________________         Date_________________

 

(Please sign and date)