Credit Application

Company Information

Company Name:

E-Mail:

Billing Information (Address, City, State, Zip)

Phone: Fax:

Accounts Payable Contact/Ext.:

Name(s) of Principal Owners or Officers

Name: Title:

Name: Title:

Bank Reference (Account from which Payment will be made)

Name: Account Number:

Address Information (Address, City, State, Zip)

Contact: Phone:

Trade References

Name: Phone:

Contact:

Address Information (Address, City, State, Zip)

Name: Phone:

Contact:

Address Information (Address, City, State, Zip)

Name: Phone:

Contact:

Address Information (Address, City, State, Zip)

I understand that terms are Net 30 days, and a Finance Charge (19.8% APR) will apply to all past due accounts. By submitting this form, I hereby authorize all references to release credit information regarding our company to The Freight Escape Inc., for applications purposes. By submitting this form I also certify that all information provided above is true and correct.

PLEASE NOTE: The Freight Escape will call or request a fax confirming your Credit Application request. NO attempt will be made to release credit information from your references until your company's intentions are confirmed.