Company Information

*=Required Information

CREDIT APPLICATION
Company Name*
Company Type	Corporation Partnership Sole Proprietor LLC
Federal I.D.*
Years in Business*
Physical Address*
City*
State*
Zip Code*
Phone (xxx-xxx-xxxx)*
Fax (xxx-xxx-xxxx)*
Email*
Website
Billing Address*
City*
State*
Zip Code*
ACCOUNTS PAYABLE INFORMATION
A/P Contact*
A/P Phone (xxx-xxx-xxxx)*
A/P Fax (xxx-xxx-xxxx)*
BANK INFORMATION
This application will also serve as an authorization to release information from your bank to Midwest Express Co. and any creditors who may need an authorization from you, the customer.
The information contained herein is confidential and is only supplied to Midwest Express Co. this also authorizes companies to fax back their reply to us.
Bank Name*
Account Number*
Bank Contact*
Bank Phone (xxx-xxx-xxxx)*
Bank Fax (xxx-xxx-xxxx)*
REFERENCES
Please list four refeences, three of which must be trucking companies you currently do business with.
Forward Air, Tax Air and Towne Air are NOT acceptable, as they do not provide credit references.
Reference 1 Company Name*
Reference 1 City*
Reference 1 Phone (xxx-xxx-xxxx)*
Reference 2 Company Name*
Reference 2 City*
Reference 2 Phone (xxx-xxx-xxxx)*
Reference 3 Company Name*
Reference 3 City*
Reference 3 Phone (xxx-xxx-xxxx)*
Reference 4 Company Name*
Reference 4 City*
Reference 4 Phone (xxx-xxx-xxxx)*
Customer Agrees to All Information Provided in Tariff.
Notes / Comments
	Load New Code

Terms and conditions: The applicant(s) executing this Application and Agreement ("Customer") hereby agree(s) that payment and services are subject to the following terms and conditions:

1) Customer agrees that all amounts due for services provided by Midwest Express Co. and/or any of its subsidiaries or affiliates, (collectively the "Company") are payable to P.O. Box 66221 Chicago, IL 60666-0221.

2) Customer agrees that all amounts due are not payable in installments, but are payable Net 30 days from date of invoice. Company reserves the right to demand payment of all outstanding and past due freight charges as a pre-condition for releasing any shipment(s) at destination. This right includes the right to demand payment upon delivery of any shipment(s) at any time. If any amount is not paid within said period a delinquency charge of 1 1/2% per month of the delinquent balance shall be added to the sum due.

3) Customer agrees that all shipments will be subject to Midwest Express Co. standard terms and conditions.

4) In the event the Account becomes delinquent and is turned over for collection, Customer agrees to pay all costs of collection including reasonable attorney fees and court costs.

5) Customer agrees to notify the Company by certified mail of any changes in ownership of Customer and further agrees to be liable for all losses incurred as a result of failure to comply with said notifications.

6) Customer authorizes the Company and/or its Credit Agency(s) to investigate all credit history, bank references and any other information required to process this application and as it deems necessary in the future.