Credit application – Dapstransport

Application Form

Basic Info

Applicant legal name: *

Federal ID: *

Trade name (if different):

Billing address:

City / State:

Zip:

Physical address:

City / State:

Zip:

Phone:

Fax:

Web address:

Contact:

Title:

E-mail:

Type of business (please check one):

Sole proprietor Partnership Corporation LLC Other

Cell:

Description of business:

Business start date:

No. of employees:

Approx. annual sales:

Approx. net worth:

Limit requested:

Sales tax exempt?

Yes No (If yes, attach exemption certificate).

A/P Contact name:

Principals: Names of Officers, Partners, Owners, Guarantors (attach additional sheets if necessary)

Full Name
Residence phone

Title
% Interest

Residence address

Full Name
Residence phone

Title
% Interest

Residence address

Full Name
Residence phone

Title
% Interest

Residence address

Bank/Finance co. reference

Name
Contact

City
Phone

State
Account #
Type

Name
Contact

City
Phone

State
Account #
Type

Has the business or any principal ever declared bankruptcy:

Yes No
Date declared:

Does the business or any principal have any outstanding liens or judgments:

Yes No

Trade references

Name
Contact

City
Phone

State
Fax

Name
Contact

City
Phone

State
Fax

Name
Contact

City
Phone

State
Fax

Insurance company

Name
Contact
Can we contact your agent on your behalf?

Yes No

City
Phone

State
Fax

Special billing instructions

Purchase order required?

Yes No
Who is allowed to charge?

(If yes, written or verbal?) If verbal: Are names instead of numbers allowed?

Yes No
Other requirements?

Terms & conditions of credit & sales:

Shipper agrees to pay for goods, services, and other items charged to its open account upon receipt of each invoice. Payment is past due if not received by DAPS Transport LLC. within 14 (fourteen) days of the date of invoice. Past due Invoices are subject to a service charge of 2.0% per month (24% APR). It is further agreed that the Shipper will pay all costs of collection, including attorney’s fees, should this account require legal proceedings to enforce payment. The undersigned warrants that all information is correct. It is understood and agreed that the undersigned specifically consents to DAPS Transport LLC., investigation of the applicant's credit history and may utilize credit reporting services for information on the applicant. The undersigned hereby authorizes the bank and trade references listed to release the information necessary to assist DAPS Transport LLC. in establishing a line of credit.

Continuing personal guaranty:

In consideration of the extension of business credit for goods and services obtained by the above designated Applicant from DAPS Transport LLC. and as an inducement to make such extension, the undersigned jointly, severally, irrevocably and unconditionally agree(s) to: (1) the terms and conditions set forth in this agreement, which are hereby fully incorporated herein by this reference; and (2) guarantee(s) the payment of any and all indebtedness, including advances, debts, obligations, and liabilities now existing or hereafter made or incurred, together with such costs and expenses, including reasonable attorney's fees, as may be incurred by DAPS Transport LLC. in the enforcement of this Guaranty, whether or not a suit is commenced. The undersigned further indemnifies and holds harmless DAPS Transport LLC. from any loss, damage, and/or expense caused by or arising out of default of or failure to pay by SHIPPER. This continuing guaranty shall not be revoked except by written notice to DAPS Transport LLC. Requesting that DAPS Transport LLC. not make any further sales and deliveries on the security of this Guaranty and until the expiration of five (5) days after such notice shall have been received by DAPS Transport LLC. by registered mail, return receipt requested. Any revocation shall be effective only with respect to merchandise shipped or delivered after the expiration of said five-day period, and shall not affect in any respect liability incurred by the undersigned prior to that time. The undersigned, and each of them, agree(s) to be bound by all terms and conditions contained in this Credit Application and Agreement and in the invoices issued hereunder which are incorporated by this reference as though fully set forth in full.

Shipper (Printed name:)
Date:

DAPS Transport LLC. (Printed name:)
Date: