Online Credit Application

Credit Application

To apply for credit with us, please download the Merchant Transport Application for Credit Charge Account by clicking on the image on the left.

Once you have completed the application, fax it to (561)-585-6522, or mail it to:

Merchant Transport
533 Bunker Road
West Palm Beach, FL 33405

(OR)

You can complete the online
Application for Credit Charge Account
below and submit it to us now.

Fields with a RED STAR ( * ) are Required:

Legal name:*

Address:*

Phone:*

Fax:

E-mail:*

Alternate Phone:

Cell phone:

Individual responsible (officer, principals, etc.):*
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Check the appropriate designation:*
Individual
Corporation
Partnership
LLC
Family owned

Federal ID#:*

License#:*

Type:*

If an individual, list your social security#:

Date started or incorporated:

Years in business: Number of employees:

Is a PO required? Yes No
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Bank or Financial Institution:

Address:

Name of representative: Phone:
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Customer References: (name, address, phone)
1.
2.
3.
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Trade associations: (name the organization in full)
1.
2.
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By submitting this application, the applicant agrees to all terms and conditions as outlined in the individual job contract, service agreement or lease agreement. The applicant agrees for MERCHANT TRANSPORT, 533 Bunker Rd, West Palm Beach, Florida 33465, (561)-585-6434 to conduct a credit background check as deemed necessary for establishing credit. The applicant must be a duly registered officer, agent or corporate official with the business applying for credit, that has the discretionary authority to act, bind, or legally represent their business. The applicant agrees personally, that all legal remedies should be and will be made to collect all outstanding amounts owed, MERCHANT TRANSPORT, Including late fees.
I agree

Date: