Atlantic Transportation Services, Inc. - Credit Application

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We hereby apply for the extension of credit by your firm and submit the following information as a basis for your consideration of our application. You are hereby authorized to investigate this information pertaining to our credit and financial responsibility.

Contact Information
Name                              Phone                               E-mail
       
Background Information


Company Information
Legal Name                     Phone                          Doing Buisness As
       
Street                             City                                State
       
Zip Code                         Type Of Business             Date Started * ex 1999
       
Company Type                 If Incorporated
 

Affiliated With


Principal Owners
Name                              Address
   
Title


*If Branch Office
Street                             City                                State
       
Branch Zip                      Branch Phone                  *Bill To
       

List any specific instructions below including the need for Purchase Orders, extra copies of the invoice, lease and well charges, rig name and number, etc below.


Trade References
#1
Name                              Street                             City
       
State                               Zip                                 Phone
    

#2
Name                              Street                             City
       
State                               Zip                                 Phone
    

#3
Name                              Street                             City
       
State                               Zip                                 Phone
    

#4
Name                              Street                             City
       
State                               Zip                                 Phone
    

#5
Name                              Street                             City
       
State                               Zip                                 Phone
    

Bank Information
Name                              Street                             City
       
State                               Zip                                 Phone
     Bank Officer                              Account Number
   

Should it be necessary to place this account for collection, I/we agree to pay all collection costs and attorney fees. I/We also agree that if part payments are made or no payments are made on the account within the terms specified that you have the right to assess and I/we agree to pay a "finance charge" computed by applying a periodic monthly rate of 1.5% to the past due balance. This is an annual percentage of 18%.

Do You Agree? Yes No



2004, Atlantic Transportation Services, Inc