HA Logistics Inc.

Our Company
About HA Logistics
Management Team
Quality
Technology

Services
Transportation Services
Supply Chain Mgt.
Transportation Mgt.
Warehouse/Distribution
Warehousing Network
Customer Mgt. Center
Rate Request
Broker Agent Opportunities

Case Studies
Case Study #1
Case Study #2

Contact Us
Locations & Numbers

Resources
Trailer Specifications
SLI
Order for Service
Credit Application
Employment Opp.
Sales Agent Opp.
Standard Bill of Lading
Trade Show Bill of Lading

Credit Application

Please be sure to fill out all required fields (*) to ensure you will receive the most accurate rate.

*HA Logistics Sales Contact:

COMPANY INFORMATION

*Name:
*Address
*City:		State:
*Zip:
Phone:	(xxx-xxx-xxxx)
Fax:	(xxx-xxx-xxxx)

*Federal Tax ID/SSN:
D&B Number:
Type of Business:
Email Address:

*Please choose :

BILLING INFORMATION

*Pay Cycle:
* Estimated Monthly Credit Requirement: $

Mail Invoice to:

*Name:
*Address:
*City:		State:
*Zip:

*Accounts Payable Contact:

*Name:
*Phone:
*Fax:
Email:

PRINCIPAL INFORMATION

First Principal:
*Name:
*Title:
City:		State:
Zip:
*Phone:	(xxx-xxx-xxxx)

Second Principal:
*Name:
*Title:
City:		State:
Zip:
*Phone:	(xxx-xxx-xxxx)

BANKING INFORMATION:

*Bank Name:
*Contact:
*Account Number:

*Phone:	(xxx-xxx-xxxx)
*Fax:	(xxx-xxx-xxxx)

EDI INFORMATION

EDI Capable:

EDI Contact Name:

Phone:

(xxx-xxx-xxxx)

Fax:

(xxx-xxx-xxxx)

Transaction Set (Check all that apply)

210 (frt Details Invoice)

820 (Remittance Advise)

997 (Transmission Acknowledgment)

AGREEMENT:

The above information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize the firm to whom this application is made to investigate references pertaining to my/our credit and financial responsibility. I/We further hold HA Logistics, Inc. harmless against any claims, direct or indirect that may result from receiving such information. A copy of this document transmitted via the HA Logistics Home Page shall be as the original.

On behalf of our company, I certify we are familiar with and agree to abide by Federal rules and regulations pertaining to the payment of transportation and other tariff charges. I/We agree to pay within HA's terms of NET 15. It is further understood that under the law, a carrier is required to discontinue further credit when a patron violates the time allowed for payment of tariff charges. Applicant shall assume any costs incurred by HA Logistics, Inc. for delinquent accounts.

Unless a greater value is declared and an excess value fee paid, it is agreed and declared that all property shipped has a released value of fifty ($0.50) cents per pound. Declared value not available on personal effects, jewelry, antiques, works of art or intangibles.

*Name of Authorized Representative:
*Title:

PLEASE PROVIDE TWO CARRIER REFERENCES:

*Business Name:
*Address:
*City:		State:
*Zip:
*Phone:	(xxx-xxx-xxxx)
*Fax:	(xxx-xxx-xxxx)

*Business Name:
*Address:
*City:		State:
*Zip:
*Phone:	(xxx-xxx-xxxx)
*Fax:	(xxx-xxx-xxxx)

Email Recipient: