CUSTOMER CREDIT APPLICATION Lange Logistics, Inc.

Company Name *

Street Address *

City *

State *

Zip Code *

Company Phone *

Company Fax

Website

Lange Logistics Contact Name *

Business Information

Industry

Fed Tax ID

Number of Employees

Credit Limit Requested $

Type of Business

Annual Revenue

State of Registration

Dunn & Bradstreet #

Name (s) of Owner/Members

Bluebook ID

Billing Information

Billing Method *

Mail

EDI

POD Required *

Yes

Billing Manager

Last Name

First Name

Title

Phone Number

Primary Billing Contact*

Last Name *

First Name *

Title *

Email *

Phone Number *

Company Contacts

Quoting*

Last Name *

First Name *

Title *

Email *

Phone Number *

Tendering*

Last Name *

First Name *

Title *

Email *

Phone Number *

Status Updates*

Last Name *

First Name *

Title *

Email *

Phone Number *

Bank Reference

Bank Name

Account Number

Officer/Contact

Phone

TERMS AND CONDITIONS

This Customer Account Application (“Application”) is made between Lange Logistics, Inc. (“Lange Logistics”) and the Applicant named below for the purpose of inducing Lange Logistics to extend credit accommodations to the Applicant in accordance with the following terms:

RIGHT TO TERMINATE. Upon approval of this Application, Lange Logistics in its sole discretion, and notwithstanding any request of Applicant, shall have the right to terminate Applicant’s credit privileges under this Application at any time without prior notice to Applicant except as otherwise provided by law.

GOVERNING TERMS. All services Applicant receives from Lange Logistics will be made in accordance with the terms and conditions of this Application and any invoices and/or other documents evidencing Applicant’s obligations to Lange Logistics, all of which are incorporated herein by this reference. These payment terms may not be extended or modified in any manner without the express written authorization of Lange Logistics’ Credit Manager.

FINANCE CHARGES AND COLLECTION FEES. The entire outstanding balance due to Lange Logistics on all invoices shall become due in full immediately upon default in the payment of any invoice. Applicant agrees to pay finance charges in the amount of 1.5% per month [18% annually] or the highest rate permitted by law, whichever is less, on any past due amount until collected. Should any action be commenced between Applicant and Lange Logistics concerning the sums due under any invoice issued by Lange Logistics to Applicant or the rights and duties of any Applicant and Lange Logistics in connection with any such invoice, the prevailing party in such action shall be entitled to, in addition to such other relief may be granted, an award as and for the actual attorney’s fees and costs incurred in bringing such action and/or enforcing any judgment granted thereafter.

SOLVENCY. Applicant affirms it is solvent, it is not currently a party to any bankruptcy proceeding, is not being dissolved or otherwise liquidating its assets and can satisfy all financial obligations. Applicant further affirms there are no open judgments, suits, or liens against Applicant. Applicant agrees to promptly notify Lange Logistics of any change in ownership. Such change in ownership may result in a change of credit granted by Lange Logistics, in its sole discretion.

GOVERNING LAW. This Application and all transactions between Applicant and Lange Logistics shall be governed by and interpreted in accordance with the laws and decisions of the state of Missouri, without regard to the conflicts of law provisions thereof and all actions and proceedings arising from, relating to or in connection with this Application or transaction shall be subject to the exclusive jurisdiction of said state. The place for any action filed in connection with this application or said transaction shall be Saint Louis, Missouri.

DESIGNATION. Applicant understands that Lange Logistics is a transportation broker (as defined by the FMCSA) who arranges for the transport of freight by an independent third-party motor carrier. Applicant agrees it will not list Lange Logistics as the carrier (or delivering carrier) on the Bill of Lading or any other document.

ACCESSORIAL CHARGES AND FEES. Accessorial charges, including but not limited to delivery appointment costs, lift gate, pallet jack, redelivery or detention may be added in order to complete delivery. Lange Logistics will work to notify Applicant of said charges in advance of incurring said charges, when and if possible.

Applicant shall not apply any deductions or fees of any kind to payments owed Lange Logistics unless said deduction/fee was agreed to in writing in advance by Lange Logistics. In no event shall Applicant apply deductions/fees of any kind after thirty (30) days from the date of delivery. Any fees/deductions applied beyond thirty (30) days shall be deemed waived and the amount will remain owed to Lange Logistics.

LOAD VALUE. Applicant understands that the independent motor carriers under contract with Lange Logistics are required to maintain cargo insurance in the amount of $100,000.00 per load. By signing below, Applicant acknowledges that loads valued in excess of $100,000.00 will not be tendered to Lange Logistics without Applicant first giving written notice to allow Lange Logistics to provide the contracted motor carrier with the opportunity to arrange for increased insurance limits. Failure by the Company to provide written notice to Lange Logistics will result in Applicant’s load only being insured up to $100,000.00 and Applicant acknowledges neither Lange Logistics or its hired motor carrier will be responsible for any and all amounts owed beyond $100,000.00.

CLAIMS PROCEDURE. In the event of cargo loss or damage, Applicant must file a claim with Lange Logistics for the loss within eight (8) months from the date of such loss, shortage or damage, which for purposes of this Agreement shall be the delivery date, or in the event of non-delivery, the date on which the loss or damage occurred. Applicant agrees to assist Lange Logistics in the pursuit of a claim, including confirming the validity of the claim and claim amount as well as completing documentation as needed for the claim process. If Lange Logistics pays a claim, Applicant automatically assigns any and all of its rights and interest in the claim to Lange Logistics upon receipt of such payment.

INDEMNIFICATION. Applicant agrees to indemnify and hold Lange Logistics harmless from and against any and all claims, actions or damages arising out of or relating to; (a) Applicant’s breach of this Application; or (b) attributable to Applicant’s negligence, act or omission, in whole or in part.

DENIAL OF CREDIT. If this Application is not fully approved or if any other adverse action is taken with respect to Applicant’s credit with Lange Logistics, Applicant has the right to request within 15 days of Lange Logistics’ notification of such adverse action, a statement of specific reasons for such action, which statement will be provided within 30 days of said request. To obtain the statement of specific reasons, please contact our credit department.

The approximate initial amount of credit that Applicant is requesting per month shall not be binding upon Lange Logistics, nor shall Lange Logistics incur liability by granting, reducing, increasing or refusing such amount. Applicant hereby certifies that the information furnished under this Application and any other financial statements furnished in connection herewith, is true and correct and that this information is being furnished to Lange Logistics for the purpose of inducing Lange Logistics to extend credit to Applicant, and understands that Lange Logistics intends to rely upon such information. Applicant understands and agrees to be bound by the above terms and conditions and upon such other terms that appear on all invoices and other documents furnished by Lange Logistics from time to time, all of which are incorporated herein by reference, and to advise Lange Logistics of any material change in the information provided herein, including but not limited to, change of ownership, address or telephone number. Applicant understands that Lange Logistics will retain this Application whether or not it is approved. *

clear

APPLICANT (FULL COMPANY NAME) *

BY AUTHORIZED AGENT: (PRINTED NAME & TITLE) *

DATE * +