New Account Application

Company Name
 
Federal ID # or SS#
For Corp Officer/Individual
Billing Address
Street
City
State
Zip
 
Physical Address
Street
City
State
Zip
Person Requesting Account

E-mail Address
 
A/P Contact Info
Name
Phone
Fax
Accounts Payable Address
(If Different)
Street
City
State
Zip
 
Common Caller's Name & Phone #
1.
2.
3.
P.O. Required?     No    Yes

Additional Notes:

Payment Terms: Net 15 days unless otherwise negotiated in writing.

Unless a greater value has been placed on a shipment at the time that a request for delivery is made to the Boulder/Denver Couriers, Denver/Boulder Couriers or Cherry Creek Couriers office, it is agreed that, in consideration of the rate being charged, the liability of Boulder/Denver Couriers, Denver/Boulder Couriers or Cherry Creek Couriers for damages to, or loss or delay of such shipment is limited to $100. If the shipper declares to the Boulder/Denver Couriers, Denver/Boulder Couriers or Cherry Creek Couriers office that the value of the shipment exceeds $100, the Boulder/Denver Couriers, Denver/Boulder Couriers or Cherry Creek Couriers office will furnish a rate which will provide insurance against the damage to, or loss or delay of the shipment at the higher value so declared by the shipper.

I have read and understand that failure to pay in accordance with the payment terms will result in a loss of service, and that I will be responsible for all Collection Costs and Expenses.

    
 
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