THE FREIGHT ESCAPE INC.
827 W. Thorndale Ave., Bensenville, IL 60106 (630)350-0555 FAX (630)350-0696

CREDIT APPLICATION

Company Name:_____________________________________________________________

Billing Address:______________________________________________________________

City:_________________________________ State:________ Zip Code:________________

Phone Number:__________________________ Fax Number:_________________________

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:___________________________________________________________________

Contact:______________________________________ Phone Number:________________

TRADE REFERENCES

Name:_______________________________________ Phone Number:________________

Address:_____________________________________ Contact:______________________

Name:_______________________________________ Phone Number:________________

Address:_____________________________________ Contact:______________________

Name:_______________________________________ Phone Number:________________

Address:_____________________________________ Contact:______________________

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

Signature and Title:_______________________________________ Date:______________