GMS Transportation
80 Eastern Avenue
Chelsea, Massachusetts
Phone (617) 889-0200
Fax  (617) 889-9332

CREDIT INFORMATION

PLEASE BE ASSURED ALL INFORMATION WILL BE HELD IN THE STRICTEST CONFIDENCE.

Legal Name & Billing Address:
Name
Street Address
City
State
Zip
Area Code
Phone # Fax #
Person to Contact
Type of Business
Email Address
Web Site
Name &Address 
of Parent Company:

Legal Ownership: Proprietorship Partnership Corporation

Principals
Name Address Title Soc. Sec.

Name and Address of Landlord/Mortgage Holder:

Trade References:
1. Name 2. Name
Address Address
City/State City/State
Zip Zip
Phone # (xxx) xxx-xxxx Phone # (xxx) xxx-xxxx
3. Name
Address
City/State
Zip
Phone # (xxx) xxx-xxxx

Bank Reference:

Name Person to Contact
Area Code Phone # Checking Acct. #
Address Loan Acct. $
City
State
Zip

I hereby authorize you, as my bank of record, to release credit information to GMS.

SIGNED
FULL NAME OF FIRM

BY
NAME

TITLE