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Credit Application

Invoicing Information

Type of Business:

CorporationPartershipIndividual

Does your company accept electronic invoicing?

YesNo

Pay By

Credit terms are 30 days. If you do not pay within 30 days, what are your terms?

Individual or department responsible for the payment of the freight charges.

Parent Company Information (if applicable)

Credit References

Please provide at least one vendor/transport reference.

Credit References

Please provide at least one vendor/transport reference.

Credit References

Please provide at least one carrier/transport reference.

Credit References

Please provide at least one carrier/transport reference.

Additional Information

Has your company ever filed for bankruptcy?

YesNo

Has your company ever had legal activity taken against it?

YesNo

If yes, please explain:

Individual person completing this application:

Providing first class transport & leasing services nationwide.

Whether you need safe, reliable chemical or bulk transportation service, Dana offers unmatched expertise, equipments and services with wide range coverage that give you more options to get the job done safely and on time.