ACCOUNT APPLICATION AND PAYMENT AUTHORIZATION FORM T: 203.521.7527 COMPANY INFORMATIONCompany Name EINPrimary ContactPhoneEmail Address Street Address City State / Province / Region ZIP / Postal Code Check Box if Accounts Payable Address is NOT the same as Primary Contact's Address Accounts Payable Contact PhoneEmail Billing Address Street Address City State / Province / Region ZIP / Postal Code PAYMENT METHOD OPTIONSSection 1 - ACH Payment - My Account will accept ACH withdrawals. Wire Transfer - Upon choosing this payment method, your Accounts Payable contact will be provided with InXpress banking and routing information Pay by Check - Payments by check authorize InXpress to make a one-time electronic debit from your checking account or to process the check through your bank Section 2 - PAYMENT INFORMATION TO BE KEPT ON FILE Guarantee of Payment I authorize InXpress to charge the bank account details listed below for any outstanding amounts that have not been paid within 7 days of the InXpress invoice due date, along with associated late feesBANKING INFORMATIONName on Bank Account Bank Name Account NumberRouting NumberSection 3 - AUTO PAY Auto-Pay I hereby authorize InXpress to automatically debit the bank account listed above. Since the payment amount may vary, I will receive written notification of the amount and date of the charge prior to each scheduled transaction date. This authorization is valid until I provide InXpress with a written notice of cancellation. Return Fees: I understand that returned checks or ACH transactions will result in a fee of $50 eachTERMS AND CONDITIONSThe Company authorizes the opening of an account with InXpress and the investigation of references provided. The Company understands that it is ordering services from InXpress as a third-party, bill-to provider and not a transport services company, that InXpress is not a carrier or that InXpress represents any specific carrier, and that the Company will receive discounted billing from InXpress for services provided from one or more carriers. The Company acknowledges that they have read and will abide by, and be subject to, the Terms and Conditions of InXpress, which are available on our website at https://www.inxpress.com/terms-and-conditions/ and of each carrier used, which are available on their websites and/or waybills or bills of lading.The Company understands that any service failures, late freight deliveries or damage claims are handled directly by the carrier. Payment terms to InXpress will not be extended due to pending claim(s). InXpress will not be responsible for goods or materials damaged during shipment.The Company agrees to payment terms of Net 14 days FROM DATE OF INVOICE except invoices for Duties and Taxes which are due upon receipt. If the invoice isn’t paid on time, discounts may be reduced, meaning INVOICE AMOUNTS MAY INCREASE ON ALL INVOICES UNPAID AFTER THE DUE DATE. Also, carrier services may be curtailed until the account is brought current. All costs of collection, including but not limited to reasonable attorney fees if incurred, will also be the responsibility of the Company. Duties and taxes may be invoiced up to 6 months after shipment. Invoice delivery method is via e-mail. I certify that all the information furnished above is correct, that I have proper authority to sign on behalf of the Company, that the Company is not insolvent and is in good standing I have read and agree to all the Terms and Conditions in this Account Application and Payment Authorization. Authorized Company RepresentativeMax. file size: 64 MB.SignatureMax. file size: 64 MB.Date MM slash DD slash YYYY
