Application Form

New Account / Credit Application

Invoicing Information:

Email Address for Invoices: Name: Accounts Payable Contact: Address: Phone #: City: State: Zip: Billing Requirements:

Principal Owners-Stockholders-Partners-Officers of Company:

Name
Mailing Address
City
State
Title

Bank Reference:

Bank Name: Banking Official: Address: Type of Account: City: Bank Account #: Zip: Phone #:

Carrier References (two required):

Business Name:
Address:
City:
State:
Zip:
Phone:

Additional References:

Name:
Address:
City:
State:
Zip:
Phone:

The above information is for the purpose of obtaining credit and is warranted to be true. I/we authorize Clear Lane Freight Systems(CLNI) to investigate
references and history pertaining to my/our credit; certify familiarity with and agree to abide by Federal Rules and regulations pertaining to payment of
transportation services as provided for Clear Lanes’ tariff CLNI 100 (available at www.clearlanefreight.com), specifically the regulations in Title 49. Code of
Federal Regulations, Section 377.203.

Clear Lanes’ payment terms are 15 calendar days from the presentation of the invoice unless otherwise specified in a written contract executed by the
applicant and Clear Lane. Failure to pay freight charges accordingly may subject the payer to late payment fees and the loss of discount, if any, shown on
each freight bill and / or collection charges as prescribed in CLNI 100, item 720.