Credit Application

Download Customer Packet

Applicant Name & Address
Business Name*
Employee Name*
Title
Physical Address
Street Address City State ZIP Code
Mailing address is the same as billing?
- Yes
- No
Billing Address
Street Address City State ZIP Code
Phone
Fax
Email*
Federal Tax ID #
D&B # (Optional)
Business Info & Accounts Payable
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:
Phone
Fax
Email
Email address for Freight Invoices to be sent to:*
Banking Info
Bank:
Branch:
Phone:
Address
Street Address City State ZIP Code
Office Contact:
I hereby authorize bank named above to release information requested for the purpose of obtaining and/or reviewing credit.
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*
Printed Name:*
Title:*
Date*
Date Format: MM slash DD slash YYYY
References & Misc. Documentation
Accepted file types: jpg, gif, png, pdf.
CREDIT POLICY: Invoices are rendered upon delivery of shipment.

CREDIT TERMS: All invoices are due thirty (30) days from the invoice date. All funds received by DESTINATION TRANSPORT, LLC will be applied to the oldest outstanding invoiced BOL (based on date on pick-up). All funds paid to DESTINATION TRANSPORT will be paid in USD currency. Overpayments do not accrue interest. 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.

Customer shall not solicit freight arrangement with any carrier's Destination Transport used to haul Customer's freight, when the arrangement of such shipments first became known to Customer as a result of BROKER's efforts. Unless otherwise agreed in writing, Customer shall not knowingly solicit freight arrangement for a period of 12 month(s) following termination of this agreement for any reason, with any carrier of BROKER.

(ii) In the event of breach of this provision, BROKER shall be entitled, for a period of twelve (12) months following delivery of the last shipment transported by CARRIER under this Agreement, to a commission of ten percent (10%) of the gross transportation revenue (as evidenced by freight bills) received by CARRIER for the transportation of said freight as liquidated damages. Additionally, BROKER may seek injunctive relief and in the event it is successful, Customer shall be liable for all costs and expenses incurred by BROKER, including, but not limited to, reasonable attorney's fees.

***DESTINATION TRANSPORT, LLC INSURES ALL FULL TRUCKLOAD CARGO UP TO $100,000.00 - ANY ADDITIONAL INSURANCE COVERAGE NEEDED IS AVAILABLE BUT MUST BE ARRANGED PRIOR TO PICKUP LTL AND PARTIAL SHIPMENT'S INSURANCE COVERAGE IS ASSESSED ON A LOAD BY LOAD BASIS DEPENDING ON VARIOUS FACTORS INCLUDING: WEIGHT, DIMENSIONS AND PRODUCT.***

Applicant Name & Address

Business Info & Accounts Payable

Banking Info

Trade References