Customer Registration - Speedco Logistics LLC

Basic Information:

Customer Name

Customer Email

Phone/Mobile

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Accounts Information:

Accounts Payable Phone

Accounts Payable Fax

Accounts Payable Email

Federal ID#

Any Special Billing Requirements? (AutoPay, EDI, FAX, etc)

Yes

Mention All Requirements Below.

Any Document Requirements For Payments? (Invoice, Load Confirmation, BOL)

Yes

Mention All Requirements Below.

Carrier/Business References:Minimum 3 Required*

Name

Phone/Fax

Check if you wish to add more References!

Add Each Reference Name and Contact In Each Line.

Bank Reference:

Bank Name

Account#

Contact Name

Phone

Fax Number

I understand that the information is accurate and true to the best of my knowledge and authorize Speedco Logistics, LLC. to contact the references above to obtain credit information. In the event that the amount of credit extended is placed for collection I understand that I will be responsible for all collection costs to include attorney’s fees that may be incurred by Speedco Logistics, LLC.

Available 24 Hours

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