AMB Logistic — Credit Application Complete the form. You’ll receive a confirmation within 24 hours. Website Reference & Amount Reference ID * Format: A1-1234 or A1_1234. Agent is derived from the prefix. Requested Amount * Select Amount $500$1,000$2,500$5,000$7,500 $10,000$15,000$20,000$25,000$30,000 $35,000$40,000$45,000$50,000$75,000 $100,000$125,000$150,000Other Company Information Company Name * DBA Address * Years At This Address City * State/Province * Zip/Postal Code * Country * Select Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican Samoa AndorraAngolaAnguillaAntarcticaAntigua and Barbuda ArgentinaArmeniaArubaAustraliaAustriaAzerbaijan BahamasBahrainBangladeshBarbadosBelarusBelgium BelizeBeninBermudaBhutanBoliviaBosnia and Herzegovina BotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin Islands Brunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroon CanadaCape VerdeCayman IslandsCentral African RepublicChadChile ChinaChristmas IslandCocos (Keeling) IslandsColombiaComoros Congo (Brazzaville)Congo, Democratic Republic of theCook IslandsCosta Rica Côte d'IvoireCroatiaCubaCuraçaoCyprusCzech Republic DenmarkDjiboutiDominicaDominican RepublicEcuadorEgypt El SalvadorEquatorial GuineaEritreaEstoniaEthiopia Falkland Islands (Malvinas)Faroe IslandsFijiFinlandFrance French GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambia GeorgiaGermanyGhanaGibraltarGreeceGreenland GrenadaGuadeloupeGuamGuatemalaGuernseyGuinea Guinea-BissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State) HondurasHong Kong, Special Administrative Region of ChinaHungaryIcelandIndia IndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsrael ItalyJamaicaJapanJerseyJordanKazakhstanKenya KiribatiKorea, Democratic People's Republic ofKorea, Republic of (South Korea)KosovoKuwait KyrgyzstanLao PDR (Laos)LatviaLebanonLesothoLiberiaLibya LiechtensteinLithuaniaLuxembourgMacao, Special Administrative Region of China Macedonia, Republic of (Macedonia, The Former Yugoslav Republic of) MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall Islands MartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States of MoldovaMonacoMongoliaMontenegroMontserratMorocco MozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlands Netherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeria NiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistan PalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeru PhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunion RomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint Lucia Saint Pierre and MiquelonSaint Vincent and GrenadinesSaint-BarthélemySaint-Martin (French part) SamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia SeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon Islands SomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpain Sri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSweden SwitzerlandSyrian Arab Republic (Syria)Taiwan, Republic of ChinaTajikistan Tanzania , United Republic ofThailandTimor-LesteTogoTokelauTonga Trinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvalu UgandaUkraineUnited Arab Emirates (UAE)United Kingdom of Great Britain and Northern Ireland (England, Scotland) United States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatu Venezuela (Bolivarian Republic of)VietnamVirgin Islands, USWallis and Futuna Islands Western SaharaYemenZambiaZimbabwe Phone Fax Tax Identification # Motor Carrier # DUNS # Contact Information First Name * Last Name * Title Email * Phone Ownership Legal Form CorporationPartnershipIndividual Incorporated Within the Past 12 Months? NoYes Principals Name of Principal Address City State Zip Phone Name of Principal Address City State Zip Phone Name of Principal Address City State Zip Phone Invoicing Accounts Payable Contact Phone Fax Email Address Invoicing Email Address Use a Freight Payment Company?NoYes Name of Freight Payment Company Address of Freight Payment Company Additional billing requirements?NoYes Use a Billing Portal?NoYes URL Username Password Trade References Business Name Address City State Zip Fax Phone Business Name Address City State Zip Fax Phone Business Name Address City State Zip Fax Phone Business Name Address City State Zip Fax Phone Request Comments (400 characters max) Supporting Documentation (PDF/Image, ≤4MB each) Billing Portal setup instructions Terms & Acknowledgments — AMB Logistic Non-binding application. This submission requests a credit review and does not constitute approval, commitment, or an offer. Accuracy & authority. You confirm the information is true and you are authorized to submit it on behalf of the applicant. Verification. You authorize AMB Logistic to verify trade references and business credit information, contact listed references and providers, and obtain or exchange business credit data from bureaus and relevant agencies solely to evaluate this application. Documents & signature. An AMB Logistic agent will review your submission, request any additional documents, and provide final documents for your review. No account is opened until you have reviewed and e-signed the final agreement sent by the agent. Communications & e-records. You consent to receive application-related communications electronically and to use electronic signatures and records where permitted by law. Access you share. If you provide temporary portal credentials for billing setup, you confirm you are permitted to do so and may revoke such access after completion. We will take reasonable measures to safeguard credentials and files. Intellectual property. Uploaded files must be yours or shared with permission. I agree to the Terms & Acknowledgments. Signature (type full legal name) * Submit the Request Analyzing details… Analyzing details…
