Customer Signup
Complete and submit the following infomation to become a Coyote Courier Customer:
Company Name  
Tax ID
or SSN
Street Address
Suite or Apt.
City
State
ZIP
Years In Business
Phone Number
Fax Number
Billing Address
Suite or Apt.
City
State
ZIP
Primary Business Contact
Phone Number
Accounts Payable Contact
Phone Number
Require Reference Names?
Require P.O. Numbers?
Estimated Monthly Volume $
Credit Limit Requested $
Additional Information or Notes
Promotional Code or Sales Rep.

Terms & Conditions of Account: Invoices are mailed on the 15th and the last day of each month.  They are due upon receipt and past due at 30 days. If client fails to tender an invoice payment to Coyote Courier Services within 30 days, client shall pay Coyote Courier Services in addition to the past-due payment a late charge equal to 15% of the total amount past due (not less than $10) for each late payment or the maximum amount legally allowed by law, whichever is greater. In the even of default or litigation for lack of payment, the undersigned company agrees to pay all collection fees, interest and attorney fees whether or not suit is filed. Applicant's acknowledgement represents financial responsibility, ability and willingness to pay Coyote Courier Services invoices in accordance with the above terms.  Coyote Courier Services is not responsible for any claim in excess of $100.00 per shipment, whether the result of loss, damage, delay, non-delivery, or mis-information.

I agree to the terms and conditions above and also confirm that I have the authority to make this agreement.   In the following box, type "I Agree"

Person Completing Form
Title
E-Mail Address
Copyright 2006 Coyote Courier Services, LLC. All rights reserved.