JMD Transportation Services, Inc.

To apply for credit, please fill out the application form below. Once you have all of the required items entered, print the form, and FAX to JMD Transportation, Inc. at 913.432.6439, or send via U.S. Mail to:

JMD Transportation Services, Inc.
6400 Glenwood, Suite 311
Shawnee Mission, KS 66202.

For your convenience, the link below will display the completed form on a white background and send the form to your printer; if after printing you find something that needs to be changed, you may make the changes on the form, and print the information again, until you branch to another page. When ready to print, please click on the link below:

PRINT THIS FORM

Applicant's Name:
Mailing Address:
City:	State:	Zip:
Phone:	Fax:

Parent Company:
Address:
City:	State:	Zip:
Phone:	Fax:

Organization: Corporation Partnership Proprietorship Other

Federal Tax Number:	State Tax #:
Dun & Bradstreet ID#:	Required POD:
Type of Business:
Date of Incorporation:	State:
Corporate Officers:
President:
Vice President:	Secretary:
Treasurer:

Principal Bank Name:
Address:
City:	State:	Zip:
Phone:	Fax:
Bank Representative:
Account#:	Account Type:

Credit Reference 1
Name:
Address:
City:	State:	Zip:
Phone:	Fax:
Credit Limit:

Credit Reference 2
Name:
Address:
City:	State:	Zip:
Phone:	Fax:
Credit Limit:

Credit Reference 3
Name:
Address:
City:	State:	Zip:
Phone:	Fax:
Credit Limit:

The undersigned, to induce JMD Transportation Services, Inc. to extend credit to Applicant, and intending to be legally bound do hereby unconditionally guaranty the complete performance and satisfaction of all obligations of Applicant to JMD Transportation Services, Inc. hereinafter created or incurred by Applicant and understand and agree that JMD Transportation Services, Inc. may upon default by applicant, require immediate payment from the undersigned without first sxhausting its remedies agains Applicant.
Signature:
Title:		Date:

Credit Application