National Retail Systems, Inc.

Credit Application

National Retail Transportation, Inc/Keystone Freight Corp., Application for Credit

Required fields are marked with *

Applicant Information
* Company Name:

* Billing address:

(include Bldg.No., Floor, Suite etc.)

*1. Who is the primary contact on Bill Payment Inquiries?

Name:

Position:

*2. Is the above address your shipping address?

if not, list Shipping Point below.

Shippers Name		Address:
Contact Name:	Phone Number:
3.Note: Our Billing is Invoiced Weekly and contains all information necessary to identify Date, Merchandise, Pieces, Weight, Shipper, Consignee, Terms and Amount. Please indicate any information desired on our billing, not represented above:

4. DUNS NUMBER								Years in Business
OWNERSHIP - OFFICERS - ADMINISTRATION
THE FOLLOWING INFORMATION MUST BE PROVIDED. IT WILL BE HELD IN STRICTEST CONFIDENCE

* Please Identify your Business:

	* Name	Address	Phone
OWNER/CEO
VICE PRESIDENT FINANCE
CONTROLLER
BOOKEEPER/OFFICE MANAGER
PLEASE PROVIDE YOUR BANK AND THREE(3) TRADE REFERENCES

* Bank Name/Branch:		* Acct#:
* Bank Officer/Department:		* Phone#:

	* Business Name	* Address	* Contact/Phone No./Fax No.
1.
2.
3.

The above information may be validated and additional information secured from the reference agencies provided. In the event that National Retail Transportation, Inc./Keystone Freight Corp. is required to retain an attorney or collection agency to obtain payment of any invoice, our Company shall be liable for all reasonable collection expense including attorney's and/or collection agency fees. I furthermore certify that all the information provided on this form is correct and I understand your credit terms are net 30 days following invoicing, and agree to abide by these terms in consideration of credit extension. It is further understood that credit to our company may be suspended or canceled if our account becomes delinquent beyond these terms.

* Signed:							* Title:
		Please Print Your Name & Title (IN CAPITAL LETTERS)