Shipper Signup & Credit Application

Tell us about your company

Company Name *

Street Address *

City *

State *

Postal Code *

Phone *

Fax

Email *

Shipping Contact *

Accounts Payable Contact

Billing address is different from above

Billing Address

Special Billing Requirements

Banking & Carrier References

Bank Information

Name of Bank

Bank Contact Person

Bank Phone Number

Account Number(s)

DUNS # Optional

Federal ID / EIN Optional — for credit verification

Three Carrier References

Trucking companies or brokerages you've shipped with recently. Optional, but speeds up credit approval.

Carrier Reference #1

Carrier / Brokerage Name

Phone

Carrier Reference #2

Carrier / Brokerage Name

Phone

Carrier Reference #3

Carrier / Brokerage Name

Phone

Credit Terms & Agreement

This electronic form is a legally binding agreement enforceable by law.

Shipper Credit Application Terms

I understand the following and will abide by Evergreen Shippers, LLC company policies:

Notify Evergreen Shippers, LLC of any changes in ownership, name, address, phone number, etc.
If granted credit, our company agrees to pay our freight bills within 30 days of receipt.
Our company's financial condition is satisfactory and we will meet all financial obligations.
I authorize the release of credit information to Evergreen Shippers, LLC, which will be held in strict confidence by Evergreen Shippers, LLC.
It is agreed that our account will become C.O.D. if we fail to pay within terms.
We acknowledge that the amount past due will be charged interest at the maximum legal rate.
If legal collections are required, we will reimburse Evergreen Shippers, LLC for its attorney costs.
I am an authorized representative of the company and have the authority to execute this document.

I have read & accept all terms and conditions above.

Print Name Authorized representative

Your Email Verification will be sent here

Date Today

eSign & Submit Electronic Signature

Evergreen Agent Name If you were referred by a specific agent (optional)

Electronic Signature Disclosure: By clicking "Sign & Send" you are electronically signing this Shipper Credit Application. You agree that your electronic signature is the legal equivalent of your wet signature. By checking "I have read & accept all terms and conditions above," you consent to be legally bound by the terms and conditions of this agreement.

One more step — verify your email

Thanks ! We sent a verification link to . Click it to finish signing your credit application.

Once verified, our credit team will review your information and references and reach out within 1–2 business days with your account terms.

Didn't get the email? Check your spam folder, or call (509) 321-4380.

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