Customer Application - CJC Transport

Legal Business Name

DBA

Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Shipping Contact Name

Phone

Email

Billing address same as above?*

Billing address same as above?

Yes
No

Attention*

Address*

Street Address Address Line 2 City State ZIP Code

Email

Years in business

Years at current location

Credit limit requested

Federal ID #

Type of business

Corporation
Partnership
Forwarder

Accounts Payable Contact Name

Phone

Email

Preferred billing method

Email only
Print only
Both

What reference number(s) do you require on your invoice?(check)

BOL#
PO#
Other:

What documentation do you require with your invoice? (check)

BOL
None
Other

Bank Name

Phone

Account #

Address*

Street Address Address Line 2 City State ZIP Code

Credit Reference 1

Carrier Name

Address

Phone #

Email or Fax

Credit Reference 2

Carrier Name

Address

Phone #

Email or Fax #

Credit Reference 3

Carrier Name

Address

Phone #

Email or Fax #

All statements herein are true and accurate to the best of our knowledge. We authorize CJC Transport to make any and all inquiries necessary for action of this credit application. We hereby indemnify CJC Transport and its agents from any liability resulting from their credit survey. In consideration of the extension of credit by CJC Transport to us, we agree to promptly pay all bills in accordance with the terms expressed on the invoice, including finance charges of 1.5% per month on all overdue invoices. In the event that any suit or action instituted to collect any amount due under our account, I do hereby agree to pay, in addition to the amount owed, all legal fees incurred, including a reasonable sum for attorney’s fees that may be incurred to collect monies due. This agreement shall be construed and regulated in all respects in accordance with and pursuant to the law of the state of Missouri. The parties consent to the jurisdiction (and service of process therein) of the city of St. Louis, Missouri, the state and federal courts of St. Louis County, State of Missouri with the respect to any disputes which may arise thereunder.

Authorized Signature:

Title:

Printed Name:

Company Name:

Date:

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