TPA

Account Manager

Account Information
* denotes required fields

* Company Name:
(as it appears on bill of lading)

Date

* Salesperson:

* Carrier:

Association:

Nat A/C

Do Not Call

Good Prospect

No LTL Managed Locally

Transportation Contact:

Phone:

* Email:

VP Logistics Mgr. Traffic Mgr. Warehouse Mgr.

Other:

Routes I/B Freight

Tradeshow

Credit Hold

Utilizing Public Warehouse

Freight Locations

Canada Freight

Puerto Rico Fr.

Hawaii Freight

Mexico Freight

Vendors

Rates

No Present Pricing Discount Below TPA Discount Above TPA

Notes:

780 Northfield Avenue, Suite 201, West Orange, NJ 07052
973.669.5900, ext. 201