Please complete the form below by filling in the fields and return with a IRS tax form W-9

or other tax certificate.

We will also need relevant ACH banking information and signed. Please send on your own letterhead the bank
name, account# and routing # with signature and remittance email. We appreciate your time and help in this
matter and we value your business.

COMPANY INFORMATION
Company Name: M&S TRANSPORT INC
Address: 765 Rt 83 Ste 112
City: Bensenville State: IL Zip: 60106
Phone: 630-580-8537 Fax: 630-509-3399
President/CEO: Dejan Zlatkovic A/P Contact: Sandra Mandusic
Principal Owner Name (if not Pres/CEO):
Principal Owner Home Address:

Applicant Firm is: Corporation Partnership LLC Proprietorship

Federal Tax ID # or Social Security # if a proprietorship:
Corporation or LLC Formed: State of Incorporation:

Tax ID: 80-0771711 D&B : SIC#:

MC#: 897822 DOT#: 2569725
Description of company:
Payment Terms:

____________________________________________
Signature of Authorized Representative
_____________________________________________
Milos Stojanovic, dispatch
Printed Name and Title of authorized Representative
 281-726-4575

337 Garden Oaks Blvd. #86467

Houston, TX 77018

ACH Payment Authorization Form

Sign and complete this form to authorize PWR Logistics to make a debit to your checking or
savings account.

By signing this form you give us permission to debit your account for the amount indicated
on or after the indicated date.

Please complete the information below:

Billing Address ____________________________ Phone# ________________________

City, State, Zip ____________________________ Email ________________________

Type of Corporation: Corp LLC Partnership Sole Proprietorship

Company Name _______________________________

Name on Acct _______________________________

Bank Name _______________________________

Account Number _______________________________

Bank Routing # _______________________________

Bank City/State _______________________________

Company Name _______________________________
Tax ID _______________________________

SIGNATURE DATE
PWR LOGISTICS INC

8 2 5 4 0 3 0 0 8

06/21/2018