CREDIT APPLICATION DOWNLOAD CUSTOMER PACKET Applicant Name & Address Business Name* Employee Name* Title Physical Address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Mailing address is the same as billing? Yes No 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 Name: Branch Name / Number: Address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Contact Name: Email Address: Phone Number: Fax Number: 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* MM slash DD slash YYYY 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, 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.*** Our Privacy Policy | Website and content © 2018 DestiNATION Transport, All Rights Reserved. Anoka website development