Become a CitySprint Customer

Customer Information

Billing Address
(street/PO Box, city, state, zip)		 Pick-Up Address
(if different than billing address)
Street Address/PO Box

 Street Address
City
 City
State
 		Zip
State
 		Zip
 
Company/Legal Name
 Phone Number
Courier Contact (name + title)
 Fax Number
AP Contact (payment contact)
 AP Phone Number
Business Classification: Corporation  Partnership  Individual  Other   Date:
Sales Tax Exempt? Yes  No Credit Limit Desired:
Account Names: (persons authorized to use account)
Email Address:
Common Caller Names:(list three)
Bank References: (list two bank references, including names, addresses and phone numbers)
Trade References: (list three local trade references, including names, addresses and phone numbers)
Special Instructions: (you would like to automatically appear on your order, which will be communicated to the dispatcher and driver)
** How Did You Hear About CitySprint?
Additional Information: (or questions that you may have)
Please check box if you are interested in ordering your delivery service online.
A G R E E M E N T S 1. The applicant (legal entity named above and its guarantors) agrees to pay all charges on this account within 30 days of invoice date. 2. The applicant agrees to pay a service charge of 1.5% a month on all bills which remain unpaid for a period of 30 days or more. 3. The applicant agrees to pay any and all costs of collection, including reasonable attorney fees. 4. The applicant warrants all information on this application to be true and authorizes Time Courier, Inc., d.b.a. CitySprint, its agents, and assigns to investigate the above references and any other data pertaining to the applicant's credit and financial responsibility.
By checking this box and submitting this application, you are agreeing to the terms shown above.