Credit Application - Accurate Transport

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Contact Profile

Contact Profile
(*) is mandatory
LEGAL BUSINESS NAME^*:
DBA^*:
DBA^*:
Federal Tax I.D. Number^*:
Credit Amount Requested^*: $
Date^*:
Accounts Payable Contact^*:
Phone #^*:
Accounts Payable Fax #:
Name of person(s) receiving e-Bills:
Email^*:
Do you require a POD, BOL or special reference # on your invoices? (Choose one)^*: YesNo

Billing Address:
Street^*:
City^*:
State^*:
Zip Code^*:

Mailing Address:
Street:
City^*:
State^*:
Zip Code^*:
How long at the above address?^*:
Former Business Address (if applicable)^*:
TYPE OF BUSINESS^*:
Date Established^*:
Estimated Annual Sales^*: $
OWNERSHIP^*:
Solo OwnerPartnershipCorporationLLCOther

PRINCIPAL:
Name^*:
Title^*:
SS#:
Home Address:
Has the firm or any of its principals ever been bankrupt?^* YesNo
If Yes, Please explain:

TRADE REFERENCES:
Name:
Address:
Contact:
Name:
Address:
Contact:
Name:
Address:
Contact:

BANK REFERENCES^*:
CheckingLoanSavings

Name:
Address:
Contact:
Name:
Address:
Contact:

PREFERRED METHOD OF PAYMENT (circle one): Credit Card ACH Transfer Company Check Wire Transfer
CARD TYPE^*:
CREDIT CARD^* #:
EXP DATE^*:
CVC^*:
NAME ON CARD^*:
BILLING ADDRESS
Street^*:
City^*:
State^*:
Zip Code^*:
CARD HOLDER EMAIL ADDRESS (FOR RECEIPTS)^*:
SIGNATURE^*:

Agreement Details

I acknowledge by signing below that I hereby authorize Worldwide Logistics of NJ, LLC and/or its affiliated companies to process payment on the above listed credit card. This credit card will be used to satisfy any services rendered by Worldwide Logistics of NJ, LLC. Any additional charges to Worldwide Logistics of NJ, LLC due to incorrect information listed above will be charged back to the customer

I (We) affirm that the facts and statements provided in this application and agreement are accurate and representative of my (our) affairs as of this date. By signing this application, I (We) hereby authorize Worldwide Logistics of NJ, LLC d/b/a Accurate Transport to contact the credit references, and other sources, to initially and periodically investigate my (our) credit standing for the purpose of maintaining this credit relationship. If credit is approved, I (We) agree to pay in accordance with your terms. I (We) represent and warrant that this request for credit is for business purposes only and not for personal, family, or household purposes. I (We) have obtained any authorization necessary to sign this Agreement for the provision of motor carrier transportation and related services by Worldwide Logistics of NJ, LLC d/b/a Accurate Logistics.

I (We) understand that all invoices are due and payable within 15 days following the invoice date and that interest of 1.5% per month (or the highest legal rate) shall be assessed on all invoices not paid within 15 days. This agreement is entered into in the State of New Jersey and shall be governed by the laws of the State of New Jersey without regard to its conflicts of law principles. In the event Worldwide Logistics of NJ, LLC d/b/a Accurate Logistics

Signature^*:
Title^*:
Date^*:

CREDIT APPLICATION-Accurate Logistics

Contact Profile

Billing Address:

Mailing Address:

OWNERSHIP^*:

PRINCIPAL:

TRADE REFERENCES:

BANK REFERENCES^*:

PREFERRED METHOD OF PAYMENT (circle one): Credit Card ACH Transfer Company Check Wire Transfer

BILLING ADDRESS

Agreement Details

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CREDIT APPLICATION-Accurate Logistics

Contact Profile

Billing Address:

Mailing Address:

OWNERSHIP*:

PRINCIPAL:

TRADE REFERENCES:

BANK REFERENCES*:

PREFERRED METHOD OF PAYMENT (circle one): Credit Card ACH Transfer Company Check Wire Transfer

BILLING ADDRESS

Agreement Details

OWNERSHIP^*:

BANK REFERENCES^*: