Client Code Request Form

This form is to be used in lieu of the "Consignee Request Form." Please indicate as much details as possible. Thank you.

Reason for Client Code Request: *

Explain/Comments:

Type of Business *
N/A
Trial Shipment
Agent-Routed Shipment
Co-Load Business
Personal Effects
Outport

Explain/Comments (Broker name, Agent name, etc.) :

Referred by: *

Referral Explanation:

Is this a NEW sales lead we can pursue? *

Company Related to:

Cash Before Release:(SCARBROUGH must be paid before release) *

Accounting: *
BILL TO
NOT BILL TO

If not BILL TO, Name BILL TO CODE:

Name *

Address

City

State

Zip Code

Country *

Phone *

Extension

Fax

Contact

FID#

Requested by: *

Comments