Cargo Application Form

Cargo Application Form and Service Agreement

Party Identification

Applicant Name:    Provider Name:

Effective Date:

Applicant Contact Information

  Individual      Corporation      Partnership      Other

Provider (Carrier) Information

Recitals

WHEREAS, Applicant desires to engage Provider to arrange, transport and/or handle cargo as set forth in this Application and Service Agreement; and

WHEREAS, Provider represents that it is duly authorized, licensed and insured to perform the requested transportation services and agrees to provide such services subject to the terms and conditions of this Agreement; and

WHEREAS, the parties desire to set forth the scope, payment terms, liabilities and other operating provisions in writing.

Scope of Work

Provider will arrange carriage, handling and delivery of the cargo described below and will perform those services in accordance with carrier standard practices and applicable law. Specific services requested by Applicant must be disclosed in the field below.

Cargo Details

Hazardous Goods:   Yes      No

  Container      Refrigerated      Flatbed      Forklift required

Pickup & Delivery

Requested Pickup Date:    Requested Delivery Date:

Payment Terms

Charges: Applicant agrees to pay Provider the freight and service charges as invoiced. Estimated Total Charges:

Late Payment Fee: assessed monthly on overdue balances.

Term and Termination

Term Commencement Date:    Term Expiration Date:

Either party may terminate this Agreement for convenience upon written notice to the other party delivered not less than days prior to the intended termination date. Provider may suspend services immediately if Applicant fails to pay charges when due or presents material misinformation regarding cargo.

Confidentiality

Each party shall treat as confidential all non-public business, operational and technical information disclosed by the other party in connection with this Agreement, whether marked confidential or that which by its nature should reasonably be considered confidential. Confidential information shall not be disclosed to third parties except to employees, agents or subcontractors with a need to know and only where such recipients are bound by confidentiality obligations at least as protective as those contained herein. This obligation shall survive termination of this Agreement for a period of three (3) years.

Liability & Insurance (Summary)

Provider's liability for loss or damage shall be governed by the applicable bill of lading or transport document, applicable conventions and by the limits of liability set out in Provider's tariffs or service quotes, except as otherwise expressly agreed in writing. Applicant may request excess liability insurance at Applicant's expense. Insurance required:   Yes      No

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the state or jurisdiction indicated below, without regard to conflict-of-law principles.

Entire Agreement

This Application and Service Agreement, together with any referenced tariffs, bills of lading, quotes and attachments executed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior or contemporaneous agreements, representations or understandings, whether written or oral. No amendment shall be effective unless in writing and signed by both parties.

Declarations and Certifications

Applicant hereby certifies that the information provided in this Application is true and correct, that Applicant is the owner or authorized agent of the owner of the cargo, and that all goods are properly described, packaged and labeled for transportation. Applicant further certifies that no goods described herein are embargoed or otherwise prohibited from transport under applicable law.

Applicant Acknowledgement:   I acknowledge that I have read, understand and agree to the terms and conditions contained in this Application and Service Agreement.

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