Individual or Company Legal Name_______________________________________________________________
Street Address_______________________________________________________________________________
_______________________________________________________________________________
City____________________________________________________ State________________ Zip____________
Phone__________________________________________ Fax________________________________________
Corporation 
Limited Partnership Partnership Individual
Names of Owners, Officers, or Partners:
_______________________________________________________ Title________________________________
_______________________________________________________ Title________________________________
_______________________________________________________ Title________________________________
Federal Tax ID#/ PAN#_________________________________ Dun & Bradstreet#_________________________
Expected monthly credit required from Interport Global Logistics Pvt. Ltd.$________________________________
Contact person for Accounts Payable_______________________________________________________________
Phone__________________________________________ Fax__________________________________________
Specific Instructions/Requirements for Interport Global Logistics Pvt. Ltd. invoicing procedures:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
BANK (CHECKING ACCOUNT)
Name of Bank____________________________________ Name of Bank Official_____________________________
Address_______________________________________________________________________________________
_______________________________________________________________________________________
Account Number_________________________________________________________________________________
Phone__________________________________________ Fax____________________________________________
Page 1 of 2 BUSINESS REFERENCES
Name______________________________________________________ Phone_____________________________
Fax____________________________ Contact Name___________________________________________________
Address_______________________________________________________________________________________
_______________________________________________________________________________________
Name______________________________________________________ Phone_____________________________
Fax____________________________ Contact Name___________________________________________________
Address_______________________________________________________________________________________
_______________________________________________________________________________________
Name______________________________________________________ Phone_____________________________
Fax____________________________ Contact Name___________________________________________________
Address_______________________________________________________________________________________
_______________________________________________________________________________________
Application is hereby made and references given. It is understood that this particular information will be held in complete confidentiality and used only by the credit department of Interport Global Logistics Pvt. Ltd. If approved, I hereby agree to the credit terms of Net/30.
Signed___________________________________________________ Title______________________________
Date_________________________
Please fax completed application to 91+22+56415643 . Also please mail original to:
Interport Global Logistics Pvt. Ltd.
Attn: Credit Dept.
Shrikant Chambers, 5 & 6, Ground Floor,
Sion Trombay Road, Next to R. K. Studio,
Chembur, Mumbai - 400 071
Tel.: 91+22+56415641 (30 Lines)
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