Info About You

Info About You

We're glad you're here!
Company Information

About Your Business
Legal Company Name*
DBA (If Any)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Phone Number*
Please enter a valid phone number.
Operations Contact E-mail*
example@example.com
EIN OR Tax ID*
Motor Carrier (MC) or DOT Number, if Applicable
Contact Information

Who should we know?
Logistics Contact Name*

First NameLast Name
Logistics Contact E-mail*
example@example.com
Logistics Contact Phone Number*
Please enter a valid phone number.
Accounts Payable Contact*

First NameLast Name
Accounts Payable E-mail Address*
example@example.com
Accounts Payable Phone Number*
Please enter a valid phone number.
Billing Requirements

So we can smoothly navigate your billing process:
Preferred Payment Terms*

Pre-PayNet 15Net 30Other
Specify Other Terms
How do you prefer to receive invoices?*

EmailMail
What email address should we send invoices to?
example@example.com
Where should invoices be sent?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Requirements
What documents do we need to include with our invoices?*

Original Rate ConfirmationPODBlackbox InvoiceOther
Please specify additional documents needed for billing:
Payment Method
What's your preferred payment method?*

CheckACH
Depository Name:
Routing Number:
Account Number:
Name(s) on Account:
Remittance E-mail
You Blackbox Contact - Who Sent You This Link?*

First NameLast Name
Authorization
We hereby authorize Blackbox Logistics to initiate debit entries to our bank account for payment of freight invoices and related charges in accordance with the terms agreed upon. This authorization will remain in effect until we provide written notice of cancellation at least seven (7) business days in advance.

We affirm that the bank information provided below is accurate and that we have the authority to authorize transactions on this account.
By checking this box, I confirm I have read and agree to the ACH authorization above.
Signature*

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Info About You

Company Information

Contact Information

Billing Requirements

Billing Requirements

Payment Method

Authorization