Diamond Logistics - Freight and Logistics Broker

Shipper Questionnaire

Tell us a little about yourself.

01. General Information
In what primary industry does your company serve (e.g. manufacturing, agriculture, etc.)?*
How many shipments would you estimate you make per week?*
What modes do you typically use to ship (e.g. rail, air, over-the-road truck, etc.)?*
How is your product typically packaged for shipment (e.g. cases on pallets, drums, etc.)?*
How much do your loads ordinarily weigh (gross lbs)?*
What special requirements should we know about (e.g. refer, tri-axle chassis, etc.)?*
How regularly do you import cargo from outside of the contiguous United States (if ever)?*
How regularly do you export goods outside of the contiguous United States (if ever)?*
Section Break
02. Company Information
Company Name*
Physical Address*
Street Address City State ZIP Code
Different Mailing Address?
- Yes
- No
Mailing Address
Street Address City State ZIP Code
Phone*
Fax*
Email*
Company Contacts*
Provide necessary company contacts
Position Phone Email
03. Business Structure
Line of Business*
Date Established*
State Incorporated*
Federal ID Tax #*
Legal Structure*
- Corporation
- Partnership
- Proprietorship
Corporate Officers/Members/Owners*
Name Title Phone
04. Bank Reference
Bank Name*
Bank Address*
Street Address City State ZIP Code
Bank Phone*
Bank Fax*
Bank Officer*
Bank Officer Email*
05. Trade or Carrier References
Company #1 Name
Company #1 Contact
Company #1 Phone
Company #1 Fax
Company #1 Email
Company #2 Name
Company #2 Contact
Company #2 Phone
Company #2 Fax
Company #2 Email
Company #3 Name
Company #3 Contact
Company #3 Phone
Company #3 Fax
Company #3 Email
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Max. file size: 100 MB.
06. Agreement
I hereby assert the above information to be true and accurate to the best of my knowledge and that it is given to induce the extension of credit to the applicant. I authorize Diamond Logistics, LP to make such credit investigation as is seen fit, including contacting the references listed and the bank referenced and obtaining credit reporting agencies. I understand and agree to Net 15 payment terms. If amounts due are not paid in accordance with the payment terms, a finance charge of 0.05% per day (18% per year) will be added to all past due invoices. Credit privileges are subject to immediate suspension or revocation if any undisputed invoices are not paid within payment terms or if the balance due exceeds the approved credit limit. In the event collection is necessary, the prevailing party shall be reimbursed for all expenses incurred to collect the debt. Any collection over this Agreement which cannot be resolved by the parties shall venue in Fresno, California, and the prevailing party to any such dispute, shall, in addition to any amount awarded, also receive reasonable attorney fees and costs. The signature below indicates I am an authorized representative of the company and have the authority to sign and execute this credit agreement.
Printed Name*
Title/Position*
Date
MM slash DD slash YYYY
Signature
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