Credit Application — Little Victories Logistics

01 · Company Information

Legal Company Name *

DBA (if applicable)

Entity type *

Federal EIN *

DUNS # (optional)

Year established *

Employees

02 · Billing Address

Street address *

Suite / floor

City *

State / Prov. *

Postal code *

Country *

Main phone *

03 · Accounts Payable Contact

Name *

Title

Email *

Phone *

Preferred invoice delivery

Terms requested

04 · Trade References (three required)

Reference #1 — Company *

Contact / Phone *

Email

Reference #2 — Company *

Contact / Phone *

Email

Reference #3 — Company *

Contact / Phone *

Email

05 · Bank Reference

Bank name

Bank contact

Bank phone

Years as customer

06 · Estimated Volume

Estimated monthly shipments

Estimated monthly spend (USD)

Primary modes needed

Additional notes

07 · Authorization

Credit check consent. The applicant authorizes Little Victories Logistics to run a credit background check and to verify the information above with the references and third-party sources provided. *

Terms & conditions. The applicant agrees that all shipments tendered to Little Victories will be subject to Little Victories' standard broker terms and conditions, available at littlevictorieslogistics.com/terms. *

Accuracy. The information provided in this application is true and correct to the best of the applicant's knowledge. *

08 · Signature

Printed name *

Title *

Date *

Typed signature *

By typing your name, you agree it constitutes an electronic signature under the E-SIGN Act.

Creditapplication.

Credit
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