credit application

Tidewater Transit Co., Inc.

P.O. Box 189 Kinston, NC 28502 | Phone: 252-523-4103 | Fax: 252-523-0748

Credit Application

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Legal Name of Business(Required)

Trade Name (if any)

Physical Address(Required)

Street Address Address Line 2 City ZIP Code

Mailing Address(Required)

Street Address Address Line 2 City ZIP Code

Business Phone(Required)

Business Fax

Business Email(Required)

Business Type(Required)

Number of Employees(Required)

Years in Business(Required)

Principal Owner(s) or Officer(s) | Name & Title:(Required)

References

Please include at least two bulk transportation references. If unable to supply sufficient references, TWT may require a wire transfer of funds to establish credit.

Reference 1(Required)

Account Number(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City ZIP Code

Reference 2(Required)

Account Number(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City ZIP Code

Reference 3(Required)

Account Number(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City ZIP Code

Reference 4(Required)

Account Number(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City ZIP Code

Upload a Reference Sheet or W9

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Signature(Required)

Title(Required)

Date(Required)

credit application

Tidewater Transit Co., Inc.