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©Copyright 1988 - 2010 Shelba D. Johnson Trucking, Inc.™, All Rights Reserved.

Credit Application

Required fields are marked with an * asterisk.
Shelba D. Johnson Trucking, Inc. Contact Name*  
Line of Credit Requested*  


Business Information

Business Name:  Phone:  FAX: 
Registered Company Address: 
City:  State:  Zip: 
How long at this address:     Email Address: 
Billing Address if different: 
City: State:  Zip: 
Delivery Address if different: 
City: State:  Zip: 
DBA:     Federal Tax ID: 
Type of Business:  Date Established: 
Does State, County, or City require a license?  If yes, License #: 
Number of Employees:     Estimated Annual Sales:     Sales Area:


Business Ownership

Ownership:   
 
Principal Name:      Title:      SSN: 
Home Address: 
 
Principal Name:  Title:  SSN: 
Home Address: 


Bank and Debt Information

Bank Reference:    Contact:  Phone: 
Address:  City:     State: Zip: 
Type of account  Account number
Savings
Checking
Other
Has the Company or any of its Principals ever files for bankruptcy:   
If yes, explain: 
Mortgage Holder/Landlord: 
Address:  Phone: 


Other Business Debts

Name:     Address:     Phone: 
Name:  Address:  Phone: 
Name:  Address:  Phone: 


Business/Trade References

Company Name:  Contact: 
Address:    City:    State:    Zip: 
Phone:    FAX:    Email: 
Type of account: 
 
Company Name:  Contact: 
Address:    City:    State:    Zip: 
Phone:    FAX:    Email: 
Type of account: 
 
Company Name:  Contact: 
Address:    City:    State:    Zip: 
Phone:    FAX:    Email: 
Type of account: 


Agreement

Applicant agrees to pay any collection costs incurred to collect the outstanding balance on all accounts, including attorney’s fees.
Applicant concurs with Shelba D. Trucking, Inc Tariff
The undersigned           submit a Financial Statement
The undersigned as an inducement to grant credit warrants that the information submitted is true and correct. You are authorized to investigate the credit references listed above.


Signatures

    
Name Title       Name Title 
    
Name Title       Name Title 


Personal Guarantee

In consideration of credit being extended by Shelba D. Johnson Trucking, Inc. to the above named applicant for deliveries to be made whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, a S-corporation, or other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to Shelba D. Johnson Trucking, Inc. the faithful payment, when due, of all accounts of said applicant for deliveries made within five years after the date of this application.
Any revocation of this guarantee shall be in writing and delivered to Shelba D. Johnson Trucking, Inc., P.O. Box 7287, High Point, NC 27264.
    
Name Title       Name Title 
    
Name Title       Name Title