Credit Application Form | JDSB Trucking LLC

Credit Application

Required Information

Company Name

Service Type

Physical Address *

Address Line 1

Address Line 2

State

Province

Region

Postal Code

Primary Business

Maximum Load Value

Type of Freight

Estimated Loads Per Month

Email for Invoicing

Company Classification

Year Business Started

DUNS Number

EIN

Company Type *

Primary Business

Accounts Payable Information

Accounts Payable Contact

First name

Last Name

Accounts Payable Contact

Will we invoice a third party payment processor?

Yes No

Will we invoice other locations?

Yes No

Invoicing Requirements

Please select what is required when invoicing

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 Name

Last Name

Phone Number

Email Address

Business Name Associated With This Account

Checking Account Number

Credit References (Minimum of 2 References)

Credit Reference # 1

Company Name

Contact Name

First Name

Last Name

Phone Number

Email Address

Credit Reference # 2

Company Name

Contact Name

First Name

Last Name

Phone Number

Email Address

General Terms And Conditions

I Accept The Terms And Conditions Contained In this Agreement *

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. 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 submit to the jurisdiction of Illinois with any suit related thereto. Customer waives any argument or claim that Illinois lacks jurisdiction over Customer and agrees to personal and subject matter jurisdiction in Illinois. The 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

First Name

Last Name

Position

Date

Date Contact Conditions

Email Address

Signature

Credit Application

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