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Call Us At: Parcel Delivery Express pref 866-760-6469
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Parcel Delivery Express

LTL & Express LTL freight delivery company serving Maryland, Washington DC, and Virginia

Credit Application

Want to apply for a credit account with PDX? Please complete the following form, or contact us.

Company Information

Type of Business
State of Incorporation
Company Name(required)
Address
City
State
Zip
Contact Name
Phone
Email(valid email required)
Federal Tax ID #
Dun & Bradstreet #
Nature of Business
Amount of Credit Requested
Anticipated # Shipments Per Month
Most Frequently Shipped Areas
Years in Business
Date Business Started
Parent Company
Parent Company Location
Doing Business As (list all names you'll use for shipping & receiving)

Bank Reference

Bank Name
Bank Location
Bank Account #
Bank Account Type
Contact Name
Contact Phone

Billing Information (use only if billing address is different)

Company Name
Address
City
State
Zip
Dept. Responsible for Freight
Contact Name
Contact Phone
Billing Requirements & Remarks

Credit Reference 1

Name
Address
City
State
Zip
Phone

Credit Reference 2

Name
Address
City
State
Zip
Phone

Carrier Reference

Name
Account #
Address
City
State
Zip
Phone

Freight Charges - Collection
For transportation services provided, and pursuant to 49 USC 14101 (b)(1), SHIPPER and CARRIER expressly waive the "18 month" provision of 49 USC 14705(a) and replace it with "72 months". This provision applies to ALL applicant’s shipments, both during and subsequent to the initial credit period.
Electronic Signature
Submittal of this application constitutes an Electronic Signature by the Applicant.

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