Customer Application – ICI Carriers

Bank Information

Bank Name

Branch Number

Account Number

Bank Phone Number

Bank Contact Name

Credit Amount Requested

Reference 1 Name

Reference 1 Address

Reference 1 Phone

Reference 1 Fax

Reference 1 Contact

The applicant certifies that all information submitted herein is complete and accurate and authorize ICI to

Verify banking information provided. Contact trade name provided. Obtain further information about your firm from time to time. Check the information you have given us from time to time. Authorize any person we may contact to provide us with such information.

The applicant agrees to the following Payment Terms

Pay all costs incurred to collect any amount due, including all legal fees. Submit a financial statement, if requested. Fully understands and agrees to comply with ICI payment terms.

Receive copy of invoices and backups via mail?

Email Invoices to

Payment will be made with

C-TPAT Survey

To all of our valued Business Partners:

In light of CBP's minimum security criteria for C-TPAT Highway Carriers and in the interest of promoting secure and efficient trade, we would like to request that as a business partner of International Carriers (Tilbury) Inc. that you complete and return the following survey to us.

Date

Name & Title

Industry Partnership Program Verification.

Please verify your participation in the following Industry Partnership Programs.

FAST

Approved Applied N/A

C-TPAT

Approved Applied N/A

PIP

Approved Applied N/A

CSA

Approved Applied N/A

SVIP

Approved Applied N/A

Do you currently have a security policy that is enforced at your facility?

No Yes

Are your employees trained to detect and report suspicious behaviour?

No Yes

Form Acceptance & Submission

As highway carriers have the ultimate responsibility for all cargo loaded aboard their trailer or conveyance, we would like to stress the importance of supply chain security and encourage you to participate in the above mentioned industry partnership programs.

Thanks for your time and consideration,
International Carriers (Tilbury) Inc.

Do you agree to the form acceptance and submission terms?

I agree.

Customer Application Form

Company Information

Bank Information

C-TPAT Survey

Industry Partnership Program Verification.

Form Acceptance & Submission

Toll Free

1-800-240-7180