Confidential Application for Credit Confidential Application for Credit Please fill in the following information. Those marked with an (*) must be filled in. Company Details Company Name: * DBA (if applicable) Billing Address Address 1* Address 2 City* State* Zip* Phone* Phone Fax Phone Email Shipping Address Address 1 Address 2 City State Zip Phone Phone Fax fax Accounts Payable Contact Name * Accounts Payable Phone * Phone Accounts Payable Fax Phone Company / Business Information Company / Business Type Division Subsidary Branch Wholly Owned? Parent Company Details Name Address 1* Address 2 City* State* Zip* Federal Tax Number State Tax Number Dun & Bradstreet ID Type of Business Type of Industry Date Incorporated State Incorporated Corporate Officer / Owner Detail Owner / Officer #1 Name Title Home Address Address 2 City State Zip Phone Phone Officer #2 Name Title Home Address Address 2 City State Zip Phone Phone Officer #3 Name Title Home Address Address 2 City State Zip Phone Phone Bank / Credit References Principal Bank Name* Address 1* Address 2 City* State* Zip* Phone Number Phone Fax Fax Representative Account Number Account Type Credit Reference #1 Name Address 1 Address 2 City State Zip Phone Number Fax Fax Fax Email Contact Person Credit Line $ Credit Reference #2 Name Address 1 Address 2 City State Zip Phone Number Fax Fax Fax Email Contact Person Credit Line $ Credit Reference #3 Name Address 1 Address 2 City State Zip Phone Number Phone Fax Fax Email Contact Person Credit Line $ Credit Reference #4 Name Address 1 Address 2 City State Zip Phone Number Fax Fax Fax Email Contact Person Credit Line $ References with Matson Have you had account with a Matson Company Before? (check if yes) If so, when? Expected monthly freight charges : $ Do you have a Matson Representative? (check if yes) Name If not, would you like us to assign one? (check if yes) Disclaimer Applicant certifies that the information above and all information accompanying this application is true and correct. Applicant authorizes Matson to solicit and obtain credit information from the references above and from any other source. Applicant authorizes the references above and all other credit sources to disclose credit information to Matson. Matson will not disclose credit information about the applicant to any other person without applicant's prior written approval. Applicant agrees to pay all charges in accordance with applicable tariffs and/or terms, which will be provided or explained by applicant's Account Specialist upon request. Re Captcha Captcha validation is required ↑
