Client Application
Business Information
SECTION 1
Legal Business Name
*
DBA (Doing Business As)
Trade Name (optional)
Business Type
*
example LLC, CORP, NON PROFIT, ETC.
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Email
*
example@example.com
Company Website (if any)
Primary Contact
section 2
Contact Person Name:
*
First Name
Last Name
Tittle/Postion
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address:
*
example@example.com
Billing Information
Section 3
Billing Contact Name: (If different)
Billing Email
*
Billing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Payment Method?
Please Select
ACH / Direct Deposit
Zelle
Paypal
Card
Invoice
Service Request
Section 4
Check all that apply
Same-day delivery
Scheduled deliveries
Medical courier services
STAT / urgent deliveries
..Other
Type Of Delivery Service
Delivery Details
Section 5
Typical Pickup Location(s)?
CITY OR ZIP ZODE?
Typical Delivery Area(s)?
CITY OR ZIP CODE?
Estimated Deliveries Per Day / Week ?
*
Day
Week
Medical (ONLY if applicable)
Section 6
Type of items transported ?
What will Buddies deliver?
Any temperature requirements ?
Special handling instructions?
Special Instructions?
Section7
Access instructions
Security requirements
Delivery preferences
Declared Value Awareness
Section 8
*
I understand that shipments are subject to declared value limits and company liability policies.
Business Verification
Section 9
EIN or TAX ID NUMBER
*
*
I confirm this is a legally registered business
Agreement Acknowledgment
Section 10
*
By submitting this form, I confirm that the information provided is accurate and agree to be contacted by Buddies Courier LLC regarding services.
Signature
Section 11
Authorized Representative Name
*
First Name
Last Name
Authorized Signature
Todays Date?
*
-
Month
-
Day
Year
Date
Preferred Pickup Time?
Hour Minutes
AM
PM
AM/PM Option
Billing Frequency ?
Please Select
Per Delivery
Weekly Invoice
Bi-Weekly Invoice
Monthly Invoice
Requested Contract Term
Please Select
One-time Delivery
Short-Term (1-3 Months)
Long-Term (6-12 Months)
Ongoing Partnership
Continue
Continue
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