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Application for Account

Air Ground Xpress, Inc.
P.O. Box 438, Clinton, PA 15026

Business Name:
Principal Owner:
Mailing Address:
City:
Sate:
Zip:
Physical Address:
City:
State:
Zip:
Phone: -
Type of Organization:
Corporation:
Partnership:
Individual:
Type of Business:
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BANK ACCOUNTS
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Name:
Address:
City:
State:
Zip:
Account #:
Phone: -
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Name:
Address:
City:
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Account #:
Phone: -
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CREDIT REFERENCES
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Name:
Address:
City:
State:
Zip:
Type of Account:
Phone: -
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Name:
Address:
City:
State:
Zip:
Type of Account:
Phone: -
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In consideration for the granting of credit, we (I) submit the information which you may rely on as being accurate. We (I) further authorize any of our (my) creditors, including our (my) Bank References, to release information to you regarding our (my) financial status. We (I) have read and agree to be bound by the Air Ground Xpress, Inc. credit agreement as listed below.
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