WOC General Account Application

New Client General Application

General Account Application

Name of Company including DBA or Full Name of Individual (First, Middle, Last):

Federal Tax ID / EIN / Social Security #

Phone

Fax

Company Type

Date of Birth

Current Broker/Forwarder

Physical Address

City

State/Province

Zip/Postal

Country

Separate Billing Address

Billing Address

City

State/Province

Zip/Postal

Country

Operations Contact

Name

First Name

Last Name

Title

Phone

Fax

Are you interested in applying for credit?

Yes

Credit Application

Name of Company including DBA or Full Name of Individual (First, Middle, Last)

A/P Contact Name

Year Established

A/P Contact Email

Number of Employees

CFO/VP of Finance

A/P Contact Number

Referred to Western Overseas Coporation by

Credit Requirements

What charges will Western Overseas advance on your behalf?

Annual Disbursements

Duty

Freight

Other

Credit Limit Requested

D&B Number

Acknowledge & Sign

I acknowledge that unless a line of credit is established, payment to Western Overseas must be made in full via wire transfer prior to delivery/pick-up of cargo.

Initials

I acknowledge that unless a line of credit is established, payment to Western Overseas must be made in full via wire transfer prior to delivery/pick-up of cargo. By signing below, the applicant confirms receipt of and agrees to be bound by Western Overseas Corporation's terms and conditions.

By signing below, the applicant confirms receipt of and agrees to be bound by Western Overseas Corporation's terms and conditions.

Name Printed

Title

Corporate Officer's Signature

Clear

Date

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