• Credit Application

    * = required

    Applicant Information

  • For

  • Days

  • Date Format: MM slash DD slash YYYY

  • Name / Title of Owners, Partners or Officers

  • /

  • /

  • /

  • /

  • /

  • Trade References

  • Bank Information

  • Current Shipping Information

  • Customs Payment Method

  • Bond Type

  • Freight Payments

  • Transport Status

  • Point(s) of Origin

  • /Week

  • /Month

  • /Year

  • Insurance

  • By submitting this electronic form:

    You represent that the above information is true and correct.

    You authorize Agra-Services Brokerage Co. Inc. to make any inquiries deemed necessary in order to make a credit decision.

    You authorize your banks and trade references to release any and all credit information to Agra-Services Brokerage Co. Inc.

    This application is submitted to Agra-Services Brokerage Co. Inc. for the purpose of obtaining credit. Until such time as credit has been established, shipments will be handled on a certified check, limited credit or cash basis. Upon acceptance of this application, you agree to Agra-Services Brokerage Co. Inc. Standard Terms and Conditions as outlined on the reverse side of its invoices. Additionally, it is understood credit may be revoked at any time without notice by Agra-Services Brokerage Co. Inc.