Credit Application

Complete the form below to apply for credit terms with Ai Logistix Group of Companies. All information is kept confidential and used solely for credit evaluation.

* Required fields · Banking and trade references are optional but may expedite approval.

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Primary Contact & Accounts Payable

Contact Name *

Title

Email *

Phone *

Accounts Payable Contact

AP Contact Name

AP Email

AP Phone

Preferred Invoice Method

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Credit Request

Credit Amount Requested *

Requested Terms

Estimated Monthly Volume

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Billing Procedures

Are Purchase Orders (POs) required for billing? *

Yes No

Billing Procedure / Special Instructions

Billing Email (if different from AP)

Billing Address (if different)

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Banking Information

Optional

Providing banking details may help expedite your credit approval.

Bank Name

Bank Contact Name

Bank Phone

Account Number

Routing Number

Bank Address

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Trade References

Optional

Provide up to 3 trade references to expedite approval.

Reference 1

Company Name

Contact Name

Phone

Account #

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Authorization & Signature

I hereby certify that the information provided in this credit application is true and accurate. I authorize Ai Logistix Group of Companies and its affiliates to make inquiries as necessary to verify the information contained herein, including but not limited to contacting banking institutions, trade references, and credit reporting agencies. I understand that this application does not guarantee the extension of credit and that approval or denial is at sole discretion.

I agree to the above authorization and certify that all information provided is accurate. *

Printed Name (Authorized Signer) *

Title *

Signature (type full name) *

Date *

Transmitted securely & kept confidential