Credit Application


The undersigned is applying for credit with J. Rego Trucking, Inc. and agrees to abide by the terms and conditions of the Company's standard contract.

1.  Company Name_________________________________________________________________________
     and Adress       _________________________________________________________________________
                           __________________________________________________________________________

2.  Phone(    )____________________________________Fax(   )____________________________________

3.  Federal Tax ID or Social Security No._______________________________________________________

4.  Type of Business_________________________________No. of Employees________________________

5.  Date Business Established_________________________________________________________________

6.  Amount of Credit Requested_______________________________________________________________

7.  Check which is applicable to you:

       []  Corporation         []  General PartnershiP         []  Limited Partnership      []  LLC
   
       []  Sole Proprietorship     []  Other

8.  State where your company was organized____________________________________________

9.  Name and title of persons authorized to act on your behalf____________________________

10.  Trade References

       Name and Adress__________________________________________________________________
                               ___________________________________________________________________
                               ___________________________________________________________________
                               
                               Phone(   ) _________________________________________________________

       Name and Adress___________________________________________________________________
                               ___________________________________________________________________
                               ___________________________________________________________________
                               
                               Phone(   )_________________________________________________________

      
        Name and Adress___________________________________________________________________
                               ___________________________________________________________________
                               ___________________________________________________________________
                               
                               Phone(   )_________________________________________________________


 

      General Terms and Conditions

1.  All bills become payable in full 30 days after receipt.  If not paid by such time, bills are considered past due.

2.  A service charge of 18% will be added to all amounts billed if not paid by the end of the month.