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Company data

Company Legal Name*

Year Established*

D.B.A. (if applicable)

Email*

Address*

City*

State*

ZIP*

Country*

Phone Number*

Fax:

Type of Business*

Single Choice

Corporation

LLC

Partnership

SoloProprietorship

Other

DUNS Number

Sales N*

Tax ID*

Accounts Contact

Name*

Title

Phone*

Accounts Payable Contact

Name*

Title

Phone*

Payment method

Multiple Choice

Wire Transfer

Check

CAD

Credit Card

Other

Shipment Infos

I Want Shipment*

Single Choice

Always

Usually

Never

Company Legal Name*

Contact Person*

Phone*

Shipping Street*

Shipping City*

Shipping State*

Shipping ZIP*

Shipping Country*

Special Heading

Attention: the more options you order, the more expensive shipping will be

Company Legal Name*

Contact Person*

Phone*

Shipping Street*

Shipping City*

Shipping State*

Shipping ZIP*

Shipping Country*

	YES
Limit Access?	Choose if access to the pickup or delivery location in controlled, for example by a gate or a guard. See footnote for other examples
Residence - Home Business?	Correct! My business is a home office.
Delivery Appointment?	Choose if the carrier needs to contract the consignee to arrange a time frame for delivery.
Inside Delivery (Ground Floor)	Choose if the carrier must enter a building to deliver the freight. Availability of this service varies by carrier.
Call Before Delivery?	I want to receive a call before delivery.
Jigger? Pallet Jack?	A tool used for lifting and moving pallets
Lift Gate?	Choose if there is no dock or forklift. The carrier will use a platform at the rear of the truck for loading or unloading.

Any company you don't want us to hire? If yes, which one?
Do you have any preference for the day of the week and time for delivery?
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