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Credit Application

To apply for credit with Cooke Trucking Company, Inc., fill out all fields below. Be sure to read the application carefully. Incomplete applications will result in delays. If you do not currently have all information needed, feel free to print this form and fax it when completed to 336-789-7132.

Contact Information
Company/Applicant:
Mailing Address:
Mailing City and State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Mailing Zip Code:
Contact Name:
Telephone:
Toll-free Number:
Fax:
Email Address:
Shipping Information
Shipping Address if Different from Above
Shipping Address:
Shipping City and State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Shipping Zip Code:
Credit amount Requested: (Terms Net 14)
DUNS Number:
Upon submission of the completed application, you will be contacted by email within 7-10 days, depending on reference response. To check on the status of an application in process, send an email to appcheck@cooketrucking.com.