CREDIT APPLICATION - Alliance



CREDIT APPLICATION – TERMS OF PAYMENT

|COMPANY CONTACT INFORMATION |BILLING ADDRESS/ACCOUNTS PAYABLE CONTACT |

|Company Name | | | |

|Address | |Billing Address | |

| | | | |

|Representative | |AP Contact | |

|Phone | |Phone | |

|Fax | |Fax | |

|Email | |Email | |

BANK/TRADE REFERENCES Signing below authorizes the bank/vendor representative to release requested information

|Bank Name / Branch |Contact |Phone |Account # |

| | | | |

|Company Name |Contact |Phone |Fax |

| | | | |

| | | | |

| | | | |

PLEASE READ CAREFULLY: Please list the special requirements and/or attachments required by you to be included on/or with ALLIANCE SHIPPERS’ freight bill: NOTE: If you require a bill of lading attached, Alliance Shipper’s Inc. will expect the shipping location to fax the BOL at the time of shipment.

Documents (if any) to be included with invoice:

I have been advised on the date shown below ALLIANCE SHIPPERS INC.’S standard credit terms are payment in full within thirty (30) days of the invoice date. I have advised ALLIANCE SHIPPERS, INC. of the following:

Any accessorial billing will be sent after the initial invoice for transportation services by supplemental invoice

Please check ONE:

← Receive hard copy invoices via mail to the address listed above

← Receive invoices via email to the email address listed above

← Receive invoices via EDI

I, the undersigned, certify the information on this Terms of Payment form is true and correct to the best of my knowledge and, furthermore, realize my obligation to inform ALLIANCE SHIPPERS, INC. of any and all changes in the above information.

I also understand ALLIANCE SHIPPERS, INC.’S payment terms are payment in full within 30 days of the invoice date. I have advised ALLIANCE SHIPPERS, INC. that we can and will comply with these payment terms. In the event of non-payment, I consent to the exclusive jurisdiction of the Superior Court of New Jersey or the United States District Court for the District of New Jersey regarding any litigation between the parties and that in such litigation, Alliance Shippers, Inc. will be entitled to recover its legal expenses, reasonable attorney’s fees and costs of suit, pre-judgment and post judgment.

I, _____________________________________________________ have read and agree to the above Terms of Pay for ALLIANCE SHIPPERS, INC

PRINTED NAME .

__________________________________________________________ _________________________________

SIGNATURE OF OFFICER/AUTHORIZED AGENT (REQUIRED) DATE

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