About Us


Werner Credit Application

Required

To Contact the Credit Department Please Call 402-895-6640, Ext. 2220

Company Information
Company Name:
Name of Requestor:
Telephone:  -   - 
Address:
D & B Number:
MC Number:
(if motor carrier or transportation broker)
Fax:  -   - 
Billing Information
Accounts Payable Contact:
Telephone:  -   - 
E-Mail:
Fax:  -   - 
Invoices to be sent to the address above? Yes    No (fill in information below)
Billing Address:
Telephone:  -   - 
E-Mail:
Fax:  -   - 
Business Information
Business Type: Proprietorship
Partnership
Corporation
LLC
Subsidiary
If Subsidiary, Parent Company:
Location:
Phone:
Corporate Officers/Owners:
Name:
Title:
Name:
Title:
Credit Information
Approximate Number of Loads Per Week:
Bank Reference:
Bank Name:
Contact Name:
Contact Phone:   -   - 
Bank Address:
Address:
Trade References (Please include at least one truckload carrier):
Name:

Contact:
Type of Service/Product Rendered:
Telephone:  -   - 
Fax  -   - 
Name:
Address:
Contact:
Type of Service/Product Rendered:
Telephone:  -   - 
Fax  -   - 
Name:
Address:
Contact:
Type of Service/Product Rendered:
Telephone:  -   - 
Fax  -   -