General Couriers

1600 E. Lamar Blvd.
Suite 290
Arlington, Texas 76011
Phone: 214-741-6464 | Metro: 817-394-0330
Toll Free: 1-888-741-6593 | Fax: 817-664-0614

Please fill out and fax to General Couriers at the fax number show above.

Client Information

Company Name:________________________________________________________________________

Billing Address:_________________________________________________________________________

                                    Street                                       City                  State                     Zip

Telephone:(____)__________________   Fax:(____)________________________

Person to Contact For Billing:______________________________________________________

Contact For Deliveries:___________________________________________________________

Do you require P.O. number or File number for orders?  Yes / No

Company Website__________________________    Email address________________________

Credit Reference:

Name _________________________________Phone #_________________________________

Address_______________________________________________________________________

Contact_______________________________________________________________________

Name _________________________________Phone #_________________________________

Address_______________________________________________________________________

Contact_______________________________________________________________________

Terms

*All payments are due upon receipt. Any balance over (30) thirty days will have a finance charge applied at the rate of (2%) percent.

Signature_________________________________  Date_____________________

Title___________________________________________