Atejano Enterprise LLC

MC # 599042

P. O.  Box 1085

Cibolo, Texas 78108-1085

210-896-2501 Cell    210-566-7597 Fax

JOINT APPLICATION AND PAYMENT AGREEMENT

In order for Atejano Enterprise LLC to evaluate your company's credit worthiness and determine whether to extend credit under terms acceptable to our brokerage, please provide the following information:

Applicant (Legal Business Name)

_____________________________________________________________________

Street Address

_____________________________________________________________________

Mailing Address

_____________________________________________________________________

City

_____________________________________________________________________

State ______________________________   Zip Code_________________________

Telephone __________________________ Fax Number ______________________

Dun & Bradstreet #_____________________________________________________

1) Years at this location _________________ Years in business _______________

2) If branch, home office location ________________________________________  l

3) Other names and locations under which applicant is currently doing business, or has done business within the last two years:

______________________________________________________________________

______________________________________________________________________

4) Name and mailing address of person responsible for payment of freight charges:

______________________________________________________________________

Phone # ___________________________ FAX #______________________________

Credit Limit Requested (Credit Terms - 15,30,45, days as applies) $____________________________

Circle one: Partnership, Sole Proprietorship, Corporation

Major Shareholder, Partner, or Owner (not applicable to publicly traded corporations):

Name________________________________________________________________

Title__________________________________________________________________

Social Security

Number_______________________________________________________________

Home

Address_______________________________________________________________

______________________________________________________________________

______________________________________________________________________

(Attach additional sheets if necessary.)

CREDIT REFERENCES (Bank and Other Carriers and/or Vendors):

1. Bank Name__________________________________________________________

Account #_____________________________________________________________

Telephone No.________________________ Contact___________________________

2. Carrier Name ________________________________________________________

 Account #_____________________________________________________________

Telephone No.________________________ Contact___________________________

3. Vendor Name _______________________________________________________

 Account # ___________________________________________________________

Telephone No. ________________________ Contact ________________________

Authorized Signing Officer:

Signature ____________________________ Title____________________________

Print Name __________________________   Date____________________________

In the event that Atejano Enterprise LLC , at its discretion, agrees to extend credit terms to Applicant on the basis of the information provided by Applicant, such terms shall be as herein set forth and, at all times, Applicant agrees and acknowledges:  

(a) to pay to Atejano Enterprise LLC any and all sums due Atejano Enterprise LLC for services rendered by Atejano Enterprise LLC, no later than fifteen (15.30.45 as applies) calendar days, from the date of mailing of any invoice by Atejano Enterprise LLC to Applicant;

(b) that no bill of lading, manifest, or other similar document, nor any employee or agent of either party may in any respect alter or change the credit terms extended hereunder;

(c) that all accounts past due after the authorized credit period has expired will and shall be subject to a service charge of ten(10) percent per year or the maximum rate allowed by law, or, alternatively, to the loss of any discounts otherwise applicable, whichever is greater. With respect to any loss of discount and except as otherwise provided in any contract between Atejano Enterprise LLC  and Applicant, a revised freight bill or notice of imposition of such collection expense for late payment will be sent to

Applicant on or before ninety (90) days after expiration of the authorized credit period;

(d) that upon any default payment by Applicant, the entire balance owed to Atejano Enterprise LLC shall become immediately due and payable, together with all interest or other charges related thereto;

(e) to pay to and reimburse Atejano Enterprise LLC , its collection agencies, attorneys and/or other resources utilized by Atejano Enterprise LLC  to enforce its rights hereunder, any and all fees and costs incurred by Atejano Enterprise LLC  to collect any sums due it from Applicant;

(f) In the event of any action by Atejano Enterprise LLC to collect charges due it by Applicant, Applicant consents to jurisdiction under the laws of the State of Texas and venue of such suit shall be in the state or province of Texas.

(g) That Atejano Enterprise LLC may increase or decrease Applicant’s credit terms without prior notice to Applicant;

(h) that  Atejano Enterprise LLC  is authorized to contact any of the listed credit references and to obtain appropriate credit reports from agencies providing such information regarding applicant’s credit standing; and

(i) notwithstanding any of the foregoing, Applicant agrees and acknowledges that _ Atejano Enterprise LLC reserves any and all rights and remedies available to it, including carrier liens, otherwise available to Atejano Enterprise LLC  to enforce payment of any charges due Atejano Enterprise LLC  from or by Applicant.

Date of Application: _______________________________________

Signature of Applicant: _______________________________________

Applicant’s Company Name: _______________________________________

As the authorized signing officer on behalf of the Applicant, I warrant and represent that I have actual authority to sign this agreement on behalf of the Applicant and assure Atejano Enterprise LLC (broker) the full and prompt performance of all its obligations herein as set out in the above Joint Credit Application and Payment Agreement including all future advances made thereunto. 

NEW CARRIER DATA

ALL DATA MUST BE COMPLETE, CORRECT AND LEGIABLE

ICC/MC NUMBER _______________ FED ID_________________

CARRIER STATUS (Circle One):                  ACTIVE                           INACTIVE

COMPANY NAME_______________________________________________________

ADDRESS______________________________________________________________

CITY _______________________ STATE______________ ZIP __________________

TELEPHONE NUMBER (_______) ________________ EMAIL __________________

FAX NUMBER (________) ______________________

CONTACT PERSON ______________________________

INSURANCE: ATTACH A COPY OF THE CERTIFICATION INSRUANCE

CERTIFICATE OF INSURANCE IS REQUIRED BEFORE CARRIER IS USED!

CANCELLATION DATE OF INSURANCE: ____/____/____

COMPLETED BY: _________________________________

DATE: _____/_____/_____

                                    Atejano Enterprise LLC. P.O. Box 1085 Cibolo, Texas 78108-1085