JB HARRIS TRANSPORT AND LOGISTICS / CUSTOMER CREDITAPPLICATION

COMPANY INFORMATION

Name of Business:
(required)

Street Address:
(required)

Phone#:

City:
(required)

State:
(required)

Postal Code:
(required)

Fax#:

Billing Address:
(If Different)

Billing Email:

Business Type

Date Established:

D&B Number:

EIN #:

Estimated # of shipments per month:

Credit Limit Requested

CONTACTS

President/Owner:

CFO/Controller:

Accounting Contact

Phone #:

BANK REFERENCE

Financial Institution:

Contact Name:

Branch

Phone#:

Fax#:

TRADE REFERENCES

Company Name:

Phone#:

Fax#:

Contact Name:

Company Name:

Account Number:

Company Name:

Phone#:

Fax#:

Contact Name:

Company Name:

Account Number:

CUSTOMER AGREEMENT

The above named credit application certifies that the foregoing information is true and correct. We authorize the above listed Bank and Credit
references to release information to JB Harris Logistics, LLC and JB Harris Transport, LLC. for use in the evaluation of the credit request. We
also authorize JB Harris Logistics, LLC. to obtain a credit report. It is hereby agreed that freight charges will be payable within 30 days and
cannot and will not be held due to unsettled claims. Any amount not paid may be subject to an interest charge of 2% per month.

Print Name/Signature

Title

Date

TRANSPORTATION SERVICE AGREEMENT

JB Harris Logistics, LLC and JB Harris Transport, LLC is/has been appointed as one of our approved transportation suppliers.

Effective Date:

Signature of Shipper:

Printed Name:

Email Address:

Company Name: