Demanda Incumplimiento De Contrato De Prestacion De Servicios

|Delta Trucking |      |D&B Number |      |
|Applicant’s Legal Name|      |
|Applicant’s Address |     |
|City |      |State |      |Zip Code |     |
|Phone |      |Fax |      |
| || | |

|Check Appropriate Legal Entity|
| Corporation | Proprietorship | Partnership | LLC ||State of Incorporation or Formation |      |Date of Formation or Business Started |      |
|Other Name Company Uses|      |

If Applicant is a privately held proprietorship, corporation, LLC, partnership orother entity, please complete the following to provide information on all persons or entities that own 10% or more of Applicant. If Applicant is a limited partnership, please provide information onthe general partner. If Applicant is an LLC, please provide information on the managing member(s) or manager.

|Owners Name |Address |City...