Customer Credit Application




Printable Credit Application
Credit Dept
P.O. Box A, Station 1
Houma, LA 70363
Phone (985) 868-1030
Fax (985) 857-2320





Company Name *
Phone * Fax
Email  



   

BUSINESS AND CREDIT INFORMATION

   

Shipping Address

Billing Address

If branch or subsidiary,
list Home or Parent Company

Address Line 1 *
Address Line 2  
City, State, Zipcode*
Email  
Accounts Payable*
(Freight Bill) Contact
Phone
Business Contact Phone
Email Fax
Type of Entity  
Line of Business Years in Business
D-U-N-S#: Fed. Tax No.:
* Have you been the Subject of Bankruptcy Chapter 7, Chapter 11, or Chapter 13? Date Filed: Case#:



List four (4) Trade References (One Trucking Company, if possible)
Minimum of Two (2) References Required

   

Company Name

Phone

Fax

Email

Reference 1: *
Reference 2: *
Reference 3:  
Reference 4:  



I certify the information above is correct and authorize references to release any account information requested. I understand that the National Motor Freight Classification, the SAIA Series 170D Rules Tariff, and the bill of lading contain terms, including terms limiting SAIA’s liability, that apply to all freight shipped with SAIA. As a condition of doing business with SAIA, I agree to these terms, as well as the payment terms and credit policy in this credit application.


Name *
Title *



* Denotes Required Fields