TP CREDIT REQUEST Name of the agent you are working with *Company NameEmail Address *Street AddressCityState/ProvinceZIP / Postal CodePhone Number *FAX NUMBER Business InformationNature of Business *In Business Since *Is Business Seasonal? *YesNoIf Yes, indicate peak seasonBusiness Organization (Can check only one) *Sole ProprietorPartnershipCorporationLimited Liability Company Payment InformationPayment Contact *Payment Email *Payment Phone (if different from above)FAX *Is Bill of Landing/POD required for freight bill payment? *YesNoSpecial Billing Instructions * Banking InformationName of Bank *Contact Name *Phone/Fax *Account Number *Street Address *CityState/ProvinceZIP / Postal CodeTransportation References (upload file/s if necessary)Name of the companyContactPhoneupload additional file/s if necessaryDrag and Drop (or) Choose FilesEstimated Monthly Volume *Estimated DateTO BE READ AND AGREED BY APPLICANT *Applicant herein certifies that the information contained herein is true and correct and that he/she is authorized to execute this Application on behalf of the entity named above. Applicant hereby authorizes Tall Pines or any of its agents to obtain credit information from the bank, trade, transportation and credit references listed above and credit reporting companies as Tall Pines deems necessary to determine Applicant’s payment history and to report credit information to others. It is understood and agreed that all freight or other charges billed by Freight Tec are due within thirty days from the date of an invoice. All transactions and dealings between Tall Pines and Applicant shall be governed by the laws of the State and, where applicable, federal law. Tall Pines Contract Carriers will have $100,000.00 of cargo insurance. Tall Pines guarantees the Carrier is fully insured and liable for its actions while they have care, custody and control of the Applicant's freight. The Carrier's liability for cargo is $100,000.00, or other pre-arranged amount specified in writing and accepted by both parties before cargo is loaded. If Applicant needs cargo insurance above $100,000.00, they will email ops@shiptallpines.com to get a quote for the additional insurance, and to confirm insurance has been secured for the shipment before cargo is loaded on to the Carrier trailer.*Signature *Your browser does not support e-Signature field.Printed Name *Title *Date *Submit