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Account Application

Company:

Proprietor or Principal Officers Name:

Pick Up Address: Suite Number:

City: State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip Code:

Phone: Fax:

Secondary Address: Suite Number:

Person who processes invoices:

Title: Type of Business:

Email Address:

Tax ID Number:

Type of documents sent: Amount of documents sent daily:

Daily Route needed? NoYes   Same-day service? NoYes

For your billing purposes do you use reference names/numbers? NoYes

Is the business incorporated? NoYes  If so, which year?

SUBMIT

Payment Terms

Payment is due within 30 days of billing date. If the account becomes overdue, Bootleg Courier Co. LLC reserves the right to suspend service without notice. Bootleg Courier Co., LLC can add a collection surcharge of 2% per month of overdue balances. Should the account be placed with a collection agency and/or law firm, the fees associated with collection will be added to the balance due.

Insurance

It is agreed that the declared value of any shipment (including multiple packages) is not more than $100. Additional insurance may be purchased prior to the time of shipment. Claims not made within 15 days shall be deemed waived by the shipper and/or customer. Should any claim be asserted against Bootleg Courier Co., LLC by the shipper or a third party for loss or damage to merchandise handled hereunder, the shipper agrees to hold Bootleg Courier Co., LLC harmless under any such claims including attorney’s fees irrespective of the cause of loss or damage.