Credit Application

COMPANY INFORMATION
Company Name	Sales Rep or Agent
Phone Number Fax Number Address City State/Province Zip/Postal If Branch, Home Office Name & Address If Subsidiary, Parent Name & Address Type of Business State/Province If corporation, state of Incorporation Nature of Business Number of Locations Annual Sales $ Maximum Credit Required $ D-U-N-S Number - -

INVOICING INFORMATION

Do you need a "Bill of Lading" with Invoice? No    Yes

Do you need "Proof of Delivery" with Invoice? No    Yes

Mail Freight Bills To (Company Name)
Street/P.O. Box
City    State/Province    Zip/Postal

CONTACT

Individual or Dept. Responsible For Payment of Freight Charges

Phone Number

Fax Number

Shipping Contact Name

Phone

Name of Person Who Will Sign Application

If any legal action is brought to collect money for goods or merchandise sold pursuant to this credit application, Freight Management, Inc. shall be entitled to recover reasonable attorney's fees from the party listed above. These may be set by the court in the same action or in separate action brought for that purpose and are in addition to any other relief to which Freight Management, Inc. may be entitled.

	Freight Management, Inc., 2198 Gladstone Ct., Suite D, Glendale Heights, IL 60139 Phone 630-627-6560 Fax 630-627-7026 © ALL RIGHTS RESERVED 2008
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