Customer Application

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Company Name*

Where are you located?*

United States

Canada

International

Physical Address

Street Address Address Line 2 City State ZIP Code

Canadian Physical Address

Street Address Address Line 2 City Province Postal Code

International Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Business Phone Number*

Company Business Fax Number

Email Address*

Enter Email Confirm Email

Billing Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Email*

Year Business Started

Business is a*

Do you accept invoices via email?*

Email for Invoices

Accounts Payable Phone Number

MC Number

D&B Number

Will we invoice a third party payment processor?

Will we invoice other locations?

To process payment, may we exclude bills of lading from your invoice?

Can we contact you to discuss Electronic Data Interchange (EDI) transactions?

Do you require pallet exchange?

Do you reimburse for unloading charges?

Do you have the ability to pay via ACH?

To process payment, do you require load tenders?

Do you have any additional Billing requirements (i.e. EIRs, lumpers, scale tickets, other approvals)?

TLD Logistics Services Inc's terms are net 30 days from the date of invoice. Do you agree with these terms?

If your payment terms are NOT Net 30, please note your proposed terms for review.*

Requests for terms outside Net 30 will be reviewed by the TLD team. Approval is not guaranteed and will be confirmed upon review.

No. of Employees

Annual Revenue

Your Name

First Last

Upload W-9 or Credit References

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Accepted file types: pdf, Max. file size: 1 GB.

Referred to by (TLD Representative)

Referral Name

First Last

Referral Title

Referral Email

A WHOLLY OWNED SUBSIDIARY OF TOYOTA TSUSHO AMERICA

Customer Application

Referred to by (TLD Representative)

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