4295 Harris Hill Road
Buffalo, New York 14221
716.276.2045  800.649.4939
Credit Application
To apply for credit, please take a moment to fill-out the form below.
 
General Information* Indicates Required Fields
Name of Company or Individual*
Years in Business*
  Annual Sales*
$
Mailing Address*
Street Address (if different from mailing)
City*
State/Province*
ZIP*
Telephone Numbers*  (Two contact numbers required)
Area Phone No. Ext. Type
Billing Point of Contact*
E-mail Address*


Ownership Information
Business Type:*  Corporation**  Partnership  Individual  LLC
If corporation**, enter Federal ID No.
State Incorporated**  (if corporation)
Dun & Bradstreet Number

Principal #1*  (All information required)
Name
Job Title
Home Address
City
State/Province
ZIP
Social Security Number
Telephone Number
Area Phone No. Ext. Type

Principal #2*  (All information required)
Name
Job Title
Home Address
City
State/Province
ZIP
Social Security Number
Telephone Number
Area Phone No. Ext. Type

* Q1: Were any of the Principals in business before?
 Yes       No      
If "Yes," give business name and location:
If business was discontinued, give reason:
* Q2: Have you ever declared bankruptcy?
Business:   Yes       No       Personal:   Yes       No      
* Q3: Do you have any pending judgments against your firm?
 Yes       No      
* Q4: Are any of your assets pledged as collateral?
 Yes       No      
If "Yes," please indicate which assets and to whom:


Finance Information*  (All information required)
Person authorized to place order
Job Title
Bank Name
City
State/Province
ZIP
Bank Officer
Telephone Number
Area Phone No. Ext. Type
Credit line requested:
$


Credit References*  (All information required)
Reference #1*
Business Name
Contact Person
Address
City
State/Province
ZIP
Telephone Numbers
Area Phone No. Ext. Type

Reference #2*
Business Name
Contact Person
Address
City
State/Province
ZIP
Telephone Numbers
Area Phone No. Ext. Type

Reference #3*
Business Name
Contact Person
Address
City
State/Province
ZIP
Telephone Numbers
Area Phone No. Ext. Type

Reference #4*
Business Name
Contact Person
Address
City
State/Province
ZIP
Telephone Numbers
Area Phone No. Ext. Type


 
Terms:*  (All information required)

Terms are net 30 days. Interest will accrue at the rate of eighteen percent (18%) on any unpaid balance after 30 days. Should this account be placed with an attorney or collection agaency for collection, I hereby agree to pay all reasonable cost of collection, including attorney fees in the amount of twenty percent (20%). I agree to pay a twenty-five dollar ($25.00) returned check charge on all returned checks.

If an account reaches 45+ days past due, orders are subject to credit hold until the account is made current.

Advance notice will be given to Extra Mile Transportatation, LLC of any change in the business structure. Without such notice, the original principals to whom credit was first extended shall remain liable. Notice is to be given by certified or registered letter and acknowledged by return receipt. Credit policies are subject to change at the discretion of Extra Mile Transportation, LLC management. Upon acceptance of this application and the issuance of an open line of credit, the APPLICANT agrees to abide by the credit policies of Extra Mile Transportation, LLC.

I hereby agree that any legal proceedings undertaken to enforce the terms of this agreement or any other dispute involving the extension of credit will be resolved pursuant to the laws of New York, and that jurisdiction and venue will be proper in Buffalo, New York, for any such action.

I certify that all information on this form is correct, and that I am authorized to enter into this contractual relationship on behalf of this company. Permission is hereby granted to access/obtain all needed credit reports on my personal and business credit. I fully understand the credit terms, and have read all pages of this document before signing.
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*Q5: Do you understand and agree with the above statement?  
(Please indicate your agreement by checking "Yes" below.)

 Yes* Title:* 


 
Personal Guarantee:*  (All information required)

In consideration for the extension of credit by Extra Mile Transportation, LLC as requested by me, I hereby agree to personally guarantee any and all indebtedness incurred with Extra Mile Transportation, LLC, and to obide by the terms of this credit application and any subsequent contracts between the parties. I further agree to pay all past due amounts that exceed the terms hereof, and to pay any additional amounts due hereunder, including interest and attorney fees.
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*Q6: Do you understand and agree with the above statement?  
(Please indicate your agreement by checking "Yes" below.)

 Yes* Full Name:* 
City*
State/Province*
ZIP*
Social Security No.*
Security Check
Please enter the word you see into the space provided.


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