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ALL INFORMATION WILL BE VERIFIED
Company Information
Company Name:
Street Address:
Billing Address (if applicable):
City:
State:
Zip:
Country:
Main Phone Number:
Main Fax Number:
Parent Company (if applicable):
Parent Company Address:
Federal Tax ID:
Select One:
Name(s) of Principal(s):
 
Accounts Payable Contact:
Accounts Payable Phone:

What is the amount of estimated monthly credit required?
How frequently are vendor checks issued?
What is the number of days between receipt of invoice and actual mailing of check to vendor?
Which documents are required to process payment?
Bill of Lading Invoice Proof of Delivery P.O.# Other Ref #

Bank Information (Include wire transfer details on international partner accounts)
Bank Name:
Branch:
Street Address:
City:
State:
Zip:
Country:
Routing Number (ABA):
Account Number:
Contact Name:
Contact Phone Number:
Contact Fax Number:

Credit References
1
Name:
Contact Name:
Street Address:
City:
State:
Zip:
Contact Phone Number:
Contact Fax Number:
2
Name:
Contact Name:
Street Address:
City:
State:
Zip:
Contact Phone Number:
Contact Fax Number:
3
Name:
Contact Name:
Street Address:
City:
State:
Zip:
Contact Phone Number:
Contact Fax Number:

Additional Information
Commodity shipped:
Frequency of shipments:
Average USD value of shipment:
Products are new, unused goods:
Describe packaging of your goods in detail. Include description of exterior, interior information and whether items are palletized or require special loading instructions.
Damage/claim history over last 18 months, including number of claims and USD value of claims:
Settled Claims:
Pending Claims:
Insurance coverage may be available for your goods under Adcom's Open Cargo Policy for an additional fee. Please provide your name and telephone number if you would like more information on the cost and conditions of our All Risk coverage.
Your Name:
Phone:
Email:

Have you been in contact with your local office?
Yes No
If so, please provide the name of your contact.

INVOICE TERMS

  1. By tendering a shipment to Carrier for transportation, shipper, for himself and all other parties at any time having an interest in the goods, agrees to Carrier's Conditions of Contract, which can be viewed at www.adcomworldwide.com and which will be provided upon request. International air or ocean shipments may be subject to different terms as provided on the applicable bill of lading.
  2. Shipper's payment obligations for shipments reflected on this invoice and for future shipments tendered to Carrier are subject to the following additional terms. By paying this invoice shipper accepts Carrier's Conditions of Contract and the additional terms herein for future shipments it tenders to Carrier.
  3. As used herein, "Carrier" means Adcom Express, Inc. or the Adcom Worldwide station performing services to shipper, and all surface and air carriers that carry or undertake to carry the goods hereunder or perform any other services incidental to such carriage. Franchised and/or licensed Adcom Worldwide stations are owned and operated by independent businesses. Adcom Express, Inc. disclaims any liability for the acts, errors or omissions of its franchisees or licensees.
  4. As used herein, "shipper" means the person or entity for which the Carrier is rendering service, including its agents and representatives.
  5. Shipper agrees that all amounts due for services provided by Adcom Express, Inc. d.ba Adcom Worldwide and/or any of its franchisees or licensees are payable at P.O. Box 3627, Bellevue, WA. 98009
  6. All charges must be paid by shipper in advance unless the Carrier agrees in writing to extend credit to shipper. For Carrier's credit application, see www.adcomworldwide.com. The granting of credit to a shipper in connection with a particular transaction shall not be considered a waiver of this provision by the Carrier.
  7. All amounts billed to shipper are payable net 14 days from the date of the invoice. Carrier reserves the right to demand payment of all outstanding and past due charges as a pre-condition for releasing any shipment(s) at destination. Carrier may demand payment upon delivery of any shipment(s) at any time, if any amount due is not paid within said period. Carrier may assess a 2% Late Payment Fee on any invoice that is not timely paid, and interest will accrue on the unpaid amount at the rate of 15% per annum or the highest rate allowed by law, whichever is lower. Carrier shall be entitled to recover its costs of collection, including reasonable attorneys' fees, incurred to collect amounts billed by Carrier but not paid by shipper.
  8. Shipper hereby indemnifies and holds Carrier harmless from and against any and all liabilities, claims, losses, costs, damages, and expenses arising out of or related to: (a) shipper's or its agents' breach of, or failure to observe or perform any of, the warranties contained herein; (b) the negligence of shipper or its agents or the violation of any applicable laws or regulations by shipper or its agents; or (c) any and all duties, taxes, levies, fines, penalties and other outlays imposed by any authority in relation to the goods arising out of Carrier acting in accordance with shipper's instructions or in a manner customarily expected of a freight forwarder under the circumstances.
  9. Charges have been invoiced in accordance with Carrier's Conditions of Contract, and the governing rates, rules, classifications, and limitations of liability referenced therein. By paying this invoice in full shipper agrees that Carrier's charges are accurate.
  10. For domestic shipments not having a declared or insured value at the time of shipment, the total liability of Carrier shall in no event exceed $.50 per pound of each piece of the shipment which may have been lost or damaged (but not less than $50.00 per shipment) or the actual value of such piece, whichever is less, plus the amount of any transportation charges for which shipper may be liable. For international air shipments not having a declared or insured value declared at time of shipment, the total liability of Carrier shall in no event exceed 17 Special Drawing Rights (SDR) per lost or damaged kilogram. The value of 1 SDR is as determined by the International Monetary Fund at the date of judgment as converted into national currency in round figures under applicable law.
  11. For shipments having a declared or insured value on the waybill prior to acceptance by Carrier, the total liability of Carrier shall in no event exceed the declared or insured value of the shipment/piece or the actual value of the shipment/piece, whichever is less, plus the amount of any transportation charges for which shipper may be liable. An additional charge will apply for shipments having a declared or insured value as stated in the most recent tariff of Carrier. (a) Insurance on used equipment must have prior written authorization from Carrier. The value of any approved used equipment will be based on current market value. Carrier will not be responsible for mechanical derangement unless resulting from a peril covered under Carrier's open policy. (b) Carrier's maximum liability for any ENVELOPE or LETTERPAK is $25.00. (c) Exclusions: Carrier will not be responsible for loss or damage of accounts, bills or money, antiques, deeds, evidence of debt, notes, securities, negotiable instruments, bonds, jewels, watches, perishables, precious stones, live plants or animals, original works of art or artwork, glass, neon signs, lighting fixtures, data from any media, personal effects (new or used), wearing apparel (used), computer or electronic equipment (other than physical damage), or any types of models or prototypes. (d) If the sum entered on the face of the waybill as "Declared Value for Carriage" represents an amount in excess of the applicable limits of liability referred to in these Conditions, and if shipper has paid any supplementary charge that may be required by Carrier's tariffs, this shall constitute a special declaration of value for the Carrier's limit of liability.
  12. Carrier's liability for claims must be a direct result of Carrier's negligence. Payment of any claim shall be subject to proof of actual loss or damages suffered. Claims must contain a copy of the original purchase invoice and other documentation reasonably requested by Carrier. Carrier shall not be liable in any event for any consequential or special damages resulting from any damage or loss whether or not Carrier had knowledge that such damages might be incurred. Carrier shall not be liable for shipment and/or consequential loss, damage, delay or other result caused by: (a) Acts of God, perils of the air, public enemies, public authorities acting with actual or apparent authority, quarantine, riots, authority of law, unavailability in whole or in part of aircraft fuel, strikes, civil commotions or hazards or dangers incident to the state of war or nuclear risk. (b) the act or default of the shipper or consignee. (c) the nature of the shipment, or any defect, characteristic or inherent vice thereof. (d) violation by the shipper or consignee of any of the rules contained in the Conditions of Contract, including, but not limited to, improper description of commodities, improper or insufficient packaging, securing, marking, or addressing and failure to observe any of the rules relating to shipments not acceptable only under certain conditions. (e) unavailability of equipment or space therein. (f) compliance with delivery instructions from the shipper or consignee or non-compliance with special instructions from the shipper or consignee not authorized by Carrier's rules. (g) shortage of articles loaded and sealed in containers by the shipper provided the seal is unbroken at the time of delivery and the container retains its basic integrity. (h) failure of Carrier to pick-up, transport or deliver shipment by a stipulated date or time.
  13. Except as provided in the following paragraph below, receipt by the consignee of the shipment without written notification of damage on the delivery receipt shall be prima facie evidence that the shipment has been delivered in good order and condition. If loss or damage is found, a notation must be entered on the delivery manifest which accurately reflects the nature and extent of the damage.
  14. (a) If loss, damage, misdelivery or nondelivery occurs during land or domestic air carriage, unless written notice of any exception to the condition of the goods is made at the time of delivery, Carrier shall not be liable for any loss, damage or expense incurred by shipper, consignee or other claimant. In the case of concealed loss or damage the notice period is extended to seven (7) days from date of delivery. No claim shall be considered in the case of loss, damage, concealed or noted unless presented in writing to Carrier within nine (9) months from receipt of the goods. (b) If loss, damage, misdelivery or nondelivery occurs before, during or after international carriage by air, Carrier must be notified in writing of loss, damage or other expense incurred by the shipper, consignee or other claimant; (i) in the case of visible damage or concealed loss or damage to the goods, immediately after discovery of the damage and at the latest within fourteen (14) days from receipt of the goods, with privilege to Carrier to make inspection of the shipment and container within 30 days after receipt of such notice. While awaiting inspection by Carrier, the consignee must hold the shipping container and its contents in the same condition as received insofar as it is possible to do so: (ii) in the case of non delivery or misdelivery of the goods, within one hundred and twenty (120) days from the date of issue of the waybill. (c) All claims are subject to proof of value. After filing a claim, all documents required to support the claim must be in Carrier's possession within thirty (30) days from the date of Carrier's acknowledgment letter unless waived or extended by Carrier. Failure to submit all supporting documents within this time limitation will result in denial of the claim. No claim with respect to any Shipment will be entertained until all transportation and other related charges have been paid to Carrier. Shipper may not deduct the amount of any claim from these charges.
  15. Carrier shall not be liable in any action brought to enforce a claim unless the claimant has complied with Carrier's claim procedures. No claim with respect to a shipment, any part of which is received by the consignee, will be entertained until all transportation and other related charges have been paid to Carrier. Shipper may not deduct the amount of any claim from those charges. Any rights to damage against Carrier shall be extinguished unless an action is brought within two years from the date written notice is given that Carrier has disallowed the claim in whole or in part or two years from the date on which transportation stopped when involving an international air shipment.
  16. All suits against Carrier challenging the accuracy of invoiced charges must be filed and properly served by Carrier within one (1) year of the date of the invoice.
  17. Except as provided in the Conditions of Contract, these terms and conditions shall be construed in accordance with the laws of the State of Minnesota, without giving consideration to the principals of conflict of law. Any action shall be filed in the United States District Court for the District of Minnesota of the District Court for Hennepin County, Minnesota.
  18. Shipper, consignee, owner and current possessor of goods shall be liable, jointly and severally, to pay or indemnify Carrier for all claims, fines, penalties, damages, costs or other sum which may be incurred, suffered or disbursed by Carrier by reason of any violation of any of the rules contained in the tariff of Carrier or any other default of the shipper or such other parties with respect to a shipment, including all unpaid charges (including reasonable attorneys' fees) payable to Carrier on account of any shipment. Carrier shall have a lien on the shipment and any subsequent shipment for sums due and payable.
  19. Shipper agrees to notify the Carrier by certified mail of any changes in ownership of shipper and further agrees to be liable for all losses incurred as a result of failure to comply with said notifications.
  20. These terms shall be severable, and, if any part or term hereof shall be held invalid, such holding shall not affect the validity or enforceability of any other part or term hereof.
Adcom Worldwide Conditions of Contract and Invoice Terms are subject to change. Please refer to our website at www.adcomworldwide.com for current Conditions of Contract and Invoice Terms.

08012005v

Agreed To
Date:
08/15/18
Name:
Title:



Customer warrants all information provided or disbursed is accurate. You may be held legally and financially liable for any incorrect information. Adcom Terms and Conditions of Contract are available here.

Customer authorizes the Company Adcom Worldwide / Profiles-International to investigate all credit history, bank references and any other information required to process this application and as it deems necessary in the future.

ALL INFORMATION WILL BE VERIFIED
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""Recently I needed a same day truck from Woburn to NY City and you handled it well. Every time we need your service, Adcom Worldwide always comes through for us.""

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