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 Credit Application
                      

Date: 

Company Name*                         Address*                      City*                          State* Zip*
                                
 
Line of credit requested: 
Principals or Officiers
Name:  Title: 
Name:  Title: 
Name:  Title: 
Federal ID No:  Type of Business: Carrier Broker Fowarder Shipper Steamship Line 

Motor Carrier No:  Bond:  POL:  Effiiective Date: 
 
Mail Address: P.O Box:  Address:  City:  
                  State:  Zip: 
 
Person Handilng Payments to us:  Phone:  Ext:  Fax: 
 
What is required for payment (ie: pod, bol,tirs,do,ref#):

Bank Reference

Bank Name:  Address:  City:  State: 
       Zip:
Trade References 
Name:  Title: 
Name:  Title: 
Name:  Title:

CREDIT TERMS

The company agrees to the terms set forth in the Nationwide Transportation Services. rules circular. The company agrees  to credit terms of PAYMENT UPON RECEIPT of invoice, but no longer than 30 DAYS after delivery of the shipment. Any outstanding balances are subject to a 1-1/2% per month interest. The company agrees to pay any collection costs incurred to collect the account balance, including court costs, collection fees and attorney’s fees of not less than 33% of the unpaid principle and interest. As an inducement to grant credit, the undersigned agrees to the need for verification of all information on this application and authorized, and releases the banks, businesses and person identified on this application to furnish any and all information requested by Nationwide or its representative, by telephone or written correspondence, whichever Nationwide requests.
 
The undersigned warrants that the information is true and correct. As an inducement to grant credit to the undersigned agrees that Nationwide has the right to obtain the credit history of the undersigned and authorizes the release of such information by nature here.
Warrant of attorney to confess judgement: The maker(s) and endorser(s) hereof hereby authorize any attorney at law to appear in any court of record of the State of Ohio or any other state in the United States at any time after payments under this agreement or any extension of renewal hereof become due whether by acceleration or otherwise, and to waive the issuing and service of process and confess a judgement in favor of lessor against customer for the amount then appearing due under this agreement, together with costs of suit, and to release all errors and waive all right of appeal.
Date: 

Company:    Sign: 
  Title: