Corporate Account Application

In order for us to process your request, please print, fill out and fax the following authorization to us at 201.385.6191:

*Company Name ________________________________________________________________
*Type of Business _______________________________________________________________
*Billing Address _________________________________________________________________
*City __________________________________ *State ________________ *Zip code _________
*Main Contact __________________________________________________________________
*Telephone ___________________ Fax number _______________ E-mail _______________
*Company President _____________________________________________________________
*Authorized Users (Please include a list of authorized users and their departments): |__|__|__|__|

Bank References

*Bank References _________________________________________________________________
*Address _________________________________________________________________________
*Account # _______________________________________________________________________
*Person to Contact ________________________________________________________________
*Telephone ______________________________________________________________________
*Corporation Credit Card # __________________________________ *exp.date _____________

Trade References

*Company Name __________________________________________________________________
*Address _________________________________________________________________________
*Person to Contact ___________________________________*Telephone __________________

It is understood that these charges may include, but are not limited to, all tolls, parking, waiting time, stops, NO SHOWS, LATE CANCELLATIONS, etc. If a driver cannot be found, it is understood that it's our responsibility to contact A & I Transportation, Inc., in a timely manner. Failure to call our office to leave pickup-location will result in NO-SHOW charge. It is understood that cancellations must be made at least 2 hours before time of pick up. Failure to do so will result in LATE CANCELLATION charges. All charges are due upon receipt off statement, client(s) shown above, guarantee payment off any charges, include but not limited to, all collection and attorneys fees in case off delinquent balance carried over to the next statement is subject to a 1.5% monthly balance charge.

I(WE) HAVE READ, UNDERSTOOD AND AGREE TO BE BOUND BY THE TERMS AND CONDITIONS OF THIS STATEMENT.

*Authorized Signature _________________________________*Date Applied _____/____/____
Title _______________________________________________

Please attach to this form a clear and readable photocopy of both-sides of your credit card.

Thank you for choosing A & I Transportation, Inc.