Credit Application | DestiNATION Transport

Applicant Information

Business Name(Required)

Employee Name(Required)

Title

Email Address(Required)

Physical Address(Required)

Street Address City State ZIP Code

Mailing address is the same as billing?(Required)

Yes

Billing Address

Street Address City State ZIP Code

Phone Number(Required)

Fax Number(Required)

Hidden

Federal Tax ID #(Required)

Hidden

D&B # (Optional)

Federal Tax ID #(Required)

D&B # (Optional)

Business & Accounts Payable Information

Please Check One

Corporation

LLC

Sole Proprietorship

Other

Industry of Business

Years in Business

Primary Shipping Needs

Truckload

LTL

Both

Credit Required

If Division/Subsidiary - Name of Parent Company

Accounts Payable Contact

Email address for Freight Invoices to be sent to(Required)

Hidden

Phone

Hidden

Fax

Hidden

Banking Information

Bank Name(Required)

Branch Name / Number(Required)

Hidden

Phone

Address(Required)

Street Address City State ZIP Code

Contact Name

Email Address

Phone Number

Fax Number

Trade References

Name

Contact

Address

Phone

Name

Contact

Address

Phone

Name

Contact

Address

Phone

THE ABOVE INFORMATION is for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize the company to whom this application is made to investigate the references pertaining to my/our credit and financial responsibility. THE AUTHORIZED SIGNATORY SIGNING THIS APPLICATION ON BEHALF OF ITS COMPANY HAS THE POWER TO AND CONSENTS ITS COMPANY TO THE ATTACHED TERMS.

Authorized Signature(Required)

Date(Required)

Printed Name(Required)

Title(Required)

References & Misc. Documentation

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 MB.

CREDIT POLICY: Invoices are rendered upon delivery of shipment.

CREDIT TERMS: All invoices are due thirty (30) days from the invoice date. All past due invoices shall be subject to a service charge of one and a half percent (1 ½%) per month of the average outstanding balance due. All funds received by DESTINATION TRANSPORT LLC will be applied to the oldest outstanding invoiced BOL (based on date on pick-up). In the event past due invoices are turned over to an agency and/or an attorney for collection, Customer agrees to pay, in addition to the account balance, all interest payments, and collection costs including reasonable attorney fees. Force Majeure and any charges before, during or after will be at the sole discretion of Destination Transport. In the event of any legal proceedings, venue, controlling law, and jurisdiction shall be in the state of MINNESOTA, Anoka County.

***DestiNATION Transport insures all full truckload cargo under a contingent cargo policy with limits up to $100,000.00. The need for additional insurance for full truckload must be arranged and agreed upon prior to tender and pickup. Insurance coverage for less-than-truckload and partial shipments is assessed on a load-by-load basis, and is dependent on varying factors including, but not limited to, weight, dimension and type of cargo. Rates may be subject to adjustment dependent on insurance needs and requirements.***