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Required Information
Company Name
*
Service Type
*
General Cargo
Hazmat
Bonded
Refrigerated
Physical Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
--- Select country ---
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Billing Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
--- Select country ---
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Primary Business
Brokerage
Carrier
Freight Forwarder
Please provide your MC# or FF#
Maximum Load Value
*
< $50,000
$51,000-$100,000
$100,000-$250,000
$250,000-$500,000
$500,000+
Type of Freight
*
Imports / Exports
Dry Van
Flat Bed
Estimated Loads Per Month
Email for Invoicing
*
Company Classification
Year Business Started
*
DUNS Number
EIN
*
Company Type
*
Sole Prorietor
Limited Liability Company
Incorporation
Co-op
Limited Partnership
Stock Symbol
Accounts Payable Information
Accounts Payable Contact
*
First
Last
Accounts Payable Phone
*
Email
*
Will we invoice a third party payment processor?
*
Yes
No
Will we invoice other locations?
*
Yes
No
I.e Chicago office, New york office, Houston office.
Invoicing Requirements
Please select what is required when invoicing
Rate Confirmation Sheet
Purchase Order / Work Order
Transportation Order Sheet
TIR’s
Signed Accessorial Sheet / Form
Signed Proof of Delivery / Signed Bill of Lading
Do you have the ability to pay via ACH/Wire?
*
Yes
No
Do you have any additional Billing requirements?
Bank Reference
Bank Name
*
Bank Representative
*
First
Last
Phone
*
Email
*
Business Name Associated With This Account
*
Checking Account Number
*
Credit References - Minimum of 2 References
Credit Reference #1
Company Name
*
Contact Name
*
First
Last
Contact Phone
Contact Email
*
Credit Reference #2
Company Name
*
Contact Name
*
First
Last
Contact Phone
Contact Email
*
Credit Reference #3
Company Name
Contact Name
First
Last
Contact Phone
Contact Email
General Terms And Conditions
I Accept The Terms And Conditions Contained In this Agreement
*
ACCEPT
Credit will be extended on the condition that customer agrees to make payment in accordance with the terms of the invoice. Customer will not delay or withhold payment due to the alleged errors in billing or because of any other dis- put customer may have with JDSB Trucking or its affiliates or subsidiaries. Failure to make timely payments to JDSB Trucking or its affiliates or subsidiaries may result in cancellation of any credit extended. Any account that war- rants collection action will be responsible for all associated collection fees including but, not limited to, attorney’s fees, court costs, collection agency fees and interest at the rate of two percent (2%) per month. Customer hereby ac- knowledges that it is applying for credit with a company whose principal place of business is located in Illinois. Credit will be extended on the condition that customer agrees to make payment in accordance with the terms of the invoice. Customer will not delay or withhold payment due to the alleged errors in billing or because of any other dispute customer may have with JDSB Trucking or its affiliates or subsidiaries. Failure to make timely payments to JDSB Trucking or its affiliates or subsidiaries may result in cancellation of any credit extended. Any account that warrants collection action will be responsible for all associated collection fees including but, not limited to, attorney’s fees, court costs, collection agency fees and interest at the rate of two percent (2%) per month. Customer hereby acknowledges that it is applying for credit with a company whose principal place of business is located in Illinois. Customer agrees that it is availing itself to the jurisdiction and laws of Illinois with respect to this credit application and any claim involving or relating to the extension of credit and payment of bills hereunder. Customer agrees to sub- met to the jurisdiction of Illinois with any suit related thereto. Customer waives any argument or claim that Illinois lack jurisdiction over Customer and agrees to personal and subject matter jurisdiction in Illinois. Customer agrees to JDSB Trucking's attorney fees and costs related to any contest to jurisdiction in Illinois. Customer agrees to terms and conditions of JDSB Trucking Rules Tariff JDSG-100 as presented on www.jdsbtrucking.com. By checking accept, you are agreeing to these terms and conditions and are acknowledging that you have read and understand Rules Tariff JDSG-100
Name
*
First
Last
Position
*
provide References
Signature
*
Clear Signature
Date
*
Email
*
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