Reckart Logistics Credit Application Click here to download the PDF version of our Credit Application. Customer Name * RequiredBilling Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Physical Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Address * Required Telephone # * RequiredFax # * RequiredPresident or Owner * RequiredCredit Limit Requested * RequiredEstimated Loads per Week * RequiredYears in Business * RequiredOwnership changed in past yr? * RequiredDUNS #Federal Tax ID # * RequiredCORPORATE STRUCTURE * Required Individual/Sole Proprietor C Corp S Corp Partnership LLC Enter Class: C, S, P * RequiredMAXIMUM LOAD VALUE * Required $0 - $50K $51K - $100K $101K - $150K* $151K - $200K* $201K+* *Applicant must notify Reckart Logistics, Inc. in writing prior to shipment of loads valued in excess of $100,000 to allow for the purchase of additional insurance.Carrier and Credit Reference #1 * RequiredCompany Name & AddressTelephone #Fax #Contact NameCarrier and Credit Reference #2 * RequiredCompany Name & AddressTelephone #Fax #Contact NameCarrier and Credit Reference #3Company Name & AddressTelephone #Fax #Contact NameCarrier and Credit Reference #4Company Name & AddressTelephone #Fax #Contact NameAccounts Payable Contact Name * RequiredAccounts Payable Contact Phone * RequiredWill you accept invoices via email? * Required Yes No Will you accept invoices via fax? * Required Yes No Do you have the ability to pay invoices via ACH/EFT? * Required Yes No Please email ACH paperwork to: receivables@reckartlogistics.com.Terms and Conditions: 1. Applicant hereby certifies that information furnished in this application is true and correct. Applicant understands that the decision for Reckart Logistics, Inc. to extend Credit is based, in part, on the representations set forth by Applicant herein. 2. Upon signature of this application, Applicant agrees to abide the Terms and Conditions set forth in this Application. 3. All amounts due for services purchased from Reckart Logistics, Inc. are payable within 30 days from date of invoice. Interest will accrue at the rate of eighteen percent (18%) on any unpaid balance after 30 days. In the event that Reckart Logistics, Inc. deems it necessary to utilize the services of a collection agency or attorney to collect any amounts due, applicant agrees to pay all collection costs, attorney fees, and court costs. Reckart shall automatically apply a 4% processing fee to payments made by a credit card. 4. In consideration for the extension of credit by Reckart Logistics, Inc. by me, I hereby agree to personally guarantee any and all indebtness incurred with Reckart Logistics, Inc. and to abide by the terms of this application and subsequent contracts between the parties. I further agree to pay all past due amounts due hereunder. 5. Applicant agrees that Reckart Logistics, Inc. has the right to pursue reimbursement for any unpaid freight charges from the receiver or shipper should payment from Applicant remain outstanding for more than 30 days. Applicant further agrees that this right supersedes any contrary provision contained in any contract or bill of lading. 6. Applicant affirms that the financial condition of the business is satisfactory and all financial obligations can be met, that there are no open judgments, suits or liens against the company. Applicant will notify Reckart Logistics, Inc. of any change in ownership. 7. Applicant understands that accounts can be made CIA (cash in advance) or COD (collect on delivery) based on credit references, D&B credit score or if invoices are not paid within terms. 8. By signing this credit application, authorization is hereby given to Reckart Logistics, Inc. to contact any or all credit/bank references provided and pull credit reports as needed. Applicant understands that Reckart Logistics, Inc. reports payment experiences to credit report agencies. 9. Applicant understands that Reckart Logistics, Inc. is a transportation broker who will arrange for their freight to be transported by a third party motor carrier. 10. Applicant understands and agrees that Reckart Logistics, Inc. cannot fill out the Bills of Lading nor be listed on the Bills of Lading as the delivering carrier. 11. Applicant understands that motor carriers under contract with Reckart Logistics, Inc. are required to maintain cargo insurance in the amount of $100,000 per shipment. 12. By signing below, Applicant acknowledges that loads valued in excess of $100,000 will not be tendered without giving written notice to allow Reckart Logistics, Inc. and the contracted carrier the opportunity to arrange for increased insurance limits. Failure to provide written notice will result in your loads not being insured for more than $100,000. 13. Reckart Logistics, Inc. assumes all load information provided by the applicant is accurate and will not change. Adjustments to the lane, dimensions, weight or value, including corrections made by the carrier, may result in additional charges. I hereby represent that I am authorized to submit the application on behalf of the entity named above: Name (Authorized Company Representative) * Required First Last TitleSignature (Authorized Company Representative) * RequiredDate * Required MM slash DD slash YYYY For Corporations Only:Guarantee of Corporate Indebtedness As an inducement to Reckart Logistics, Inc. to allow:Corporation Hereinafter called “Corporation” to make purchase from Reckart Logistics, Inc. on a credit basis and in consideration thereof, the undersigned hereby jointly and severally guarantees the payment of all indebtedness of the Corporation to Reckart Logistics, Inc., whether heretofore or hereafter incurred, and whether or not the Corporation is presently indebted to Reckart Logistics, Inc. In the event the Corporation fails to pay any amount due within thirty (30) days of its due date, the undersigned jointly and severally agree to pay such amount to Reckart Logistics, Inc. upon demand. This instrument is intended to cover any indebtedness or liability presently owing or hereinafter incurred by the Corporation, or any extension or renewal thereof. This instrument is a guarantee of payment and is not intended and shall not be interpreted as an agreement by Reckart Logistics, Inc. to extend credit to the Corporation or as an amendment of the usual credit policy of Reckart Logistics, Inc.Name First Last SSNSignatureDate MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged. Δ