Customer Setup Form for Pro Logistics / Pro Intermodal

New Customer Set Up
Name

First NameLast Name
Refering Agent *
Company Name*
Company Name
DBA
Doing Business As (If Applicable)
Date Business Established

MonthDayYear
Date
Business Type (e.g., Manufacturer, Retailer, Distributor)*
Tax Identification Number (TIN or EIN)*
Business Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address (Only if Different from Business Address)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Main Contact*

First NameLast Name
Main Contact Phone*
Format: (000) 000-0000.
Main Contact Email*
example@example.com
Billing Contact*

First NameLast Name
Billing Phone Number*
Format: (000) 000-0000.
Billing Email*
example@example.com
Freight ShippingIntermodal ServicesWarehousingLTL / PartialFull TruckloadDrayageBondedOther
Commodities
Ex.: Produce, Seafood, Meats, Perishable Goods, Non-Perishable Goods, etc

Credit References

New Customer Set Up