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Courier Express
Corporate Office
2051 Franklin Way
Marietta, GA 30067
770-955-3030 local
888-462-2022 toll free
Account Application

COMPANY INFORMATION
Company Name:
Your Name:
E-mail:
Address 1:
Address 2:
Suite:
City: 
State: 
Zip Code:
Phone:
Fax:
Type of Business:
Years in Business:
BILLING ADDRESS (If different than above)
Company Name:
Your Name:
Address 1:
Address 2:
Suite:
City: 
State: 
Zip Code:
Phone:
Fax:
SOLE PROPRIETORSHIP
Owner Name:
PARTNERSHIP
Partner Name:
Partner Name:
CORPORATION
President Name:
Vice-Pres Name:
Secretary Name:
Registered Agent Name:
Accounts Payable Manager:
Phone:

TRADE REFERENCES
1.) Company Name:
Address:
Phone:
Contact:
2.) Company Name:
Address:
Phone:
Contact:
3.) Company Name:
Address:
Phone:
Contact:

BILLING REQUIREMENTS
Do you require references for your billing purposes? YES  NO
If so, what kind?
Does your company use bills of lading or other paperwork that need to be returned with your invoice? YES  NO
If so, what kind?

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