<h2>
	Application for Credit</h2>
<p>
	To apply for a Credit Application, fill out the form below. If you would like to fill out a printed Credit Application, <a href="/pdf/TLI_Credit_Application.pdf" target="_blank">download the PDF here</a>, and fax it to 610-792-1635, or mail it to: Translogistics Inc., 290 Main Street, Royersford, PA 19468.</p>
<hr />
<form action="creditprocess1.php" method="POST">
	<table border="0" cellpadding="0" cellspacing="0" class="credit" width="640">
		<tbody>
			<tr>
				<td width="240">
					DUNS #:</td>
				<td>
					<input name="duns" size="50" type="text" /></td>
			</tr>
			<tr>
				<td width="240">
					Name of Firm or Individual:</td>
				<td>
					<input name="company" size="50" type="text" /></td>
			</tr>
			<tr>
				<td width="240">
					Street Address:</td>
				<td>
					<input name="address1" size="50" type="text" /></td>
			</tr>
			<tr>
				<td width="240">
					&nbsp;</td>
				<td>
					<input name="address2" size="50" type="text" /></td>
			</tr>
			<tr>
				<td width="240">
					City:</td>
				<td>
					<input name="city" size="50" type="text" /></td>
			</tr>
			<tr>
				<td width="240">
					State:</td>
				<td>
					<input name="state" size="4" type="text" /></td>
			</tr>
			<tr>
				<td width="240">
					Zip Code:</td>
				<td>
					<input name="zip" size="13" type="text" /></td>
			</tr>
			<tr>
				<td width="240">
					Phone Number:</td>
				<td>
					(<input name="cphone1" size="3" type="text" />)- <input name="cphone2" size="3" type="text" /> - <input name="cphone3" size="4" type="text" /></td>
			</tr>
		</tbody>
	</table>
	<hr />
	<table border="0" cellpadding="0" cellspacing="0" class="credit" width="640">
		<tbody>
			<tr>
				<th colspan="3">
					Ownership:</th>
			</tr>
			<tr>
				<td colspan="3">
					The following information must be provided.&nbsp; It will be held in the strictest confidence.</td>
			</tr>
			<tr>
				<td colspan="3">
<input name="corptype[]" type="checkbox" value="Corporation" />Corporation&nbsp;&nbsp;&nbsp;<input name="corptype[]" type="checkbox" value="Incorporated within last 12 months" />Check here if incorporated in the last 12 months&nbsp;&nbsp;&nbsp;<input name="corptype[]" type="checkbox" value="Partnership" />Partnership&nbsp;&nbsp;&nbsp;<input name="corptype[]" type="checkbox" value="Individual" />Individual</td>
			</tr>
			<tr>
				<td class="chartheader">
					Name(s) of Principal(s)</td>
				<td class="chartheader">
					Address</td>
				<td class="chartheader">
					Phone</td>
			</tr>
			<tr>
				<td align="left" valign="top">
					<input name="princname1" size="30" type="text" /></td>
				<td align="left" valign="top">
					<textarea cols="21" name="princadd1" rows="3"></textarea></td>
				<td align="left" valign="top">
					(<input name="princ1ph1" size="3" type="text" />)- <input name="princ1ph2" size="3" type="text" />- <input name="princ1ph3" size="4" type="text" /></td>
			</tr>
			<tr>
				<td align="left" valign="top">
					<input name="princname2" size="30" type="text" /></td>
				<td align="left" valign="top">
					<textarea cols="21" name="princadd2" rows="3"></textarea></td>
				<td align="left" valign="top">
					(<input name="princ2ph1" size="3" type="text" />)- <input name="princ2ph2" size="3" type="text" />- <input name="princ2ph3" size="4" type="text" /></td>
			</tr>
			<tr>
				<td align="left" valign="top">
					<input name="princname3" size="30" type="text" /></td>
				<td align="left" valign="top">
					<textarea cols="21" name="princadd3" rows="3"></textarea></td>
				<td align="left" valign="top">
					(<input name="princ3ph1" size="3" type="text" />)- <input name="princ3ph2" size="3" type="text" />- <input name="princ3ph3" size="4" type="text" /></td>
			</tr>
			<tr>
				<td align="left" valign="top">
					<input name="princname4" size="30" type="text" /></td>
				<td align="left" valign="top">
					<textarea cols="21" name="princadd4" rows="3"></textarea></td>
				<td align="left" valign="top">
					(<input name="princ4ph1" size="3" type="text" />)- <input name="princ4ph2" size="3" type="text" />- <input name="princ4ph3" size="4" type="text" /></td>
			</tr>
		</tbody>
	</table>
	<hr />
	<table border="0" cellpadding="0" cellspacing="0" class="credit" width="640">
		<tbody>
			<tr>
				<td>
					Primary Financial Contact:</td>
				<td>
					<input name="primfincontactname" size="29" type="text" /></td>
				<td align="right">
					Phone:</td>
				<td align="left" nowrap="nowrap">
					(<input name="primfinph1" size="3" type="text" />)-<input name="prinfinph2" size="3" type="text" />-<input name="primfinph3" size="4" type="text" /></td>
			</tr>
			<tr>
				<td>
					Accounts Payable Contact:</td>
				<td>
					<input name="apname" size="29" type="text" /></td>
				<td align="right">
					Phone:</td>
				<td align="left" nowrap="nowrap">
					(<input name="apph1" size="3" type="text" />)-<input name="apph2" size="3" type="text" />-<input name="apph3" size="4" type="text" /></td>
			</tr>
			<tr>
				<td>
					Number of Years in Business:</td>
				<td colspan="3">
					<input name="yearsinbusiness" size="4" type="text" /></td>
			</tr>
			<tr>
				<td>
					Name of Largest Customer:</td>
				<td colspan="3">
					<input name="largestcustomer" size="50" type="text" /></td>
			</tr>
			<tr>
				<td colspan="4">
					Finance:</td>
			</tr>
			<tr>
				<td>
					Bank:</td>
				<td colspan="3">
					<input name="bank" size="50" type="text" /></td>
			</tr>
			<tr>
				<td>
					Bank Address:</td>
				<td colspan="3">
					<textarea cols="31" name="bankaddress" rows="3"></textarea></td>
			</tr>
			<tr>
				<td>
					Bank Officer or Dept:</td>
				<td colspan="3">
					<input name="bankoff" size="50" type="text" /></td>
			</tr>
			<tr>
				<td>
					Phone:</td>
				<td colspan="3">
					(<input name="bankph1" size="3" type="text" />) - <input name="bankph2" size="3" type="text" />- <input name="bankph3" size="4" type="text" /></td>
			</tr>
			<tr>
				<th colspan="4">
					References (of Like Industries):</th>
			</tr>
			<tr>
				<td class="chartheader">
					Business Name</td>
				<td class="chartheader">
					Address</td>
				<td class="chartheader" colspan="2">
					Phone</td>
			</tr>
			<tr>
				<td align="left" valign="top">
					<input name="ref1" size="30" type="text" /></td>
				<td align="left" valign="top">
					<textarea cols="21" name="refadd1" rows="3"></textarea></td>
				<td align="left" colspan="2" valign="top">
					(<input name="ref1ph1" size="3" type="text" />)- <input name="ref1ph2" size="3" type="text" />- <input name="ref1ph3" size="4" type="text" /></td>
			</tr>
			<tr>
				<td align="left" valign="top">
					<input name="ref2" size="30" type="text" /></td>
				<td align="left" valign="top">
					<textarea cols="21" name="refadd2" rows="3"></textarea></td>
				<td align="left" colspan="2" valign="top">
					(<input name="ref2ph1" size="3" type="text" />)- <input name="ref2ph2" size="3" type="text" />- <input name="ref2ph3" size="4" type="text" /></td>
			</tr>
			<tr>
				<td align="left" valign="top">
					<input name="ref3" size="30" type="text" /></td>
				<td align="left" valign="top">
					<textarea cols="21" name="refadd3" rows="3"></textarea></td>
				<td align="left" colspan="2" valign="top">
					(<input name="ref3ph1" size="3" type="text" />)- <input name="ref3ph2" size="3" type="text" />- <input name="ref3ph3" size="4" type="text" /></td>
			</tr>
			<tr>
				<td align="left" valign="top">
					<input name="ref4" size="30" type="text" /></td>
				<td align="left" valign="top">
					<textarea cols="21" name="refadd4" rows="3"></textarea></td>
				<td align="left" colspan="2" valign="top">
					(<input name="ref4ph1" size="3" type="text" />)- <input name="ref4ph2" size="3" type="text" />- <input name="ref4ph3" size="4" type="text" /></td>
			</tr>
		</tbody>
	</table>
	<div align="center">
		<input name="submit" type="submit" value="Submit Credit Application" /></div>
</form>
