General Info Sheet Ma「k A McGriff, Owner/President USDO丁# 291 2603 MC# 857159 EmaiI: ma「k@mcnationwide,COm Mailing Address: 1607SW llTH COUR丁UNITI 「「 LAUDERDALE FL 33312 WWW.mCnationwide,COm Phone: 954-263-3342 Fax: 954-368-5309 FEiN二46-391 5473 Bank: Capital One Spa「k insurance: Surety bonds Bond numbe「: 100316393 MC Nationwide is a加〃 service fogisf/cs company W鮎ch incIudes fmc勅〕ad seMce, L7T, /nte仰odal, (丁fanspohation /nte仰edfa万es Assocf弛oり, membe 77anspohafron Leagu?), member of仏NA /ntemod and we pa砧c小ate i両he EPA b (US Environmen
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General Info Sheet
Ma「k A McGriff, Owner/President
USDO丁# 291 2603
MC# 857159
EmaiI: ma「k@mcnationwide,COm
Mailing Address:
1607SW llTH COUR丁UNITI
「「 LAUDERDALE FL 33312
WWW.mCnationwide,COm
Phone: 954-263-3342
Fax: 954-368-5309
FEiN二46-391 5473
Bank: Capital One Spa「k
insurance: Surety bonds
Bond numbe「: 100316393
MC Nationwide is a加〃 service fogisf/cs company糾明y 〃censed, bonded, and insured
W鮎ch incIudes fmc勅〕ad seMce, L7T, /nte仰odal, MC Nationwide /s a member of 71A
(丁fanspohation /nte仰edfa万es Assocf弛oり, member of N17+ WationaI /ndus帥a1
77anspohafron Leagu?), member of仏NA /ntemodal Assoc融/on of No肩h Amehc争),
and we pa砧c小ate i両he EPA b (US Environmenfa/ Profec塙)n Ageney)
MC NAT音ONW看DE TRANSPOR丁AT漢0N LLC
1607SW 11TH COUR丁UN看TI
F丁LAUDERDALE 3331 2
0冊ce二954-263-3342
Fax: 954-368-5309
Customer Profiie
(informationaI Sheet)
Customer Name:
PhysicaI Address:
Ma臨g Address:
0冊ce/LocaI措
D&B ♯:
Accounts Payabie Contact: Name:
Federal iD#
丁elephone/Ext. Emaii
Type of Busjness: (Circie One) Corporation LLC Partnership SoIe Proprietorship Other
Owner(S) :
Year Business Established: Year Incorporated:_ Number of EmpIoyees:
Agreement ln consideration of MC Nationwide’s extension of credit
to Customer and other good and va!uabie consideration, Customer agrees that: (al Customer w旧ssue
Payment for MC’s invoices within thirty (30) days of MC’s invoice; (b) accounts which are th亜y-One (31)
days oId wi= be deIinquent and subject to review of credit p「iviiege and sha= bear interest of one and one
half percent (1 1/2 %) monthIy; (c) if co=ection is made by lawsuit or otherwise, Customer agrees to pay a=
Of MC’s coIlection costs incIuding reasonabIe attomey’s fees; (d) Customer waives and re=nquishes any
right to set-Off Customer’s cIaims (if any) against amounts due MC ; (e) copies of this Ag「eement, Whether
in the fom of facsimiIes, SCamed documents, Or OthenIVise, ShaIi be dup=cate originais and sha= be of the
Same legaI force and effect as originaI documents; and O this Agreement wi= be govemed by the Iaws of
the State of FIorida and Customer irrevocably agrees that any Iawsuit pe巾aining to this Agreement or any
Suit for coIIection of moneys owed by Customer to MC sha= oniy be fiIed in Magistrate Cou巾Or the
Superior CouれOf Broward County , FIorida, Customer submits itself/himse酬「erSeIf to the personai
jurisdiction of such Courts and irrevocabIy waives any right to assert that venue is not appropriate.
Read and Agreed this
Customer:
(Printed name of Custome子)
Signatu「e:
Authorized Agent:
(Printed name of person signing - TitIe)
F。叩W看9岬]ev. December 2014)
譜譜と諜諾語り
Request toJ Taxpaye事
Identi簡cation Numbel. and Ce鵬fication
Give Form to the
requeste「。 Do not
Send to廿Ie寡RS.
entity name, if different from above
、oYl小、心3 Check appropriato box for federal tax classification; Check only one of the followjng seven boxes: