FUELTRANSPORT CARRIER PROFILE 1. GENERAL INFORMATION
We would like to take this opportunity to thank you for choosing to do business with FUEL Transport Inc. In order to evaluate/process your account for credit, it is required to complete all the sections listed below. Thank you.
Legal Name:
DBA: (mm-dd-yyyy)
Phone:
Address:
(xxx-xxx-xxxx)
After hours: (xxx-xxx-xxxx)
FAX:
(xxx-xxx-xxxx)
Incorporation Date:
Email:
(
[email protected])
EDI Capable: YES
NO
Website:
yourdomain.com
2. CONTACTS
Dispatch 1:
Phone:
EXT:
(xxx-xxx-xxxx)
(xxxxx)
Dispatch 2:
Phone:
EXT:
Account Receivables:
Phone:
EXT:
Other Contact:
Phone:
EXT:
(xxxxx)
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
(xxxxx)
(xxxxx)
(xxx-xxx-xxxx)
3. EQUIPMENTS
Number of:
Trucks: (xxxxx)
Trailers:
Drivers:
Brokers:
(xxxxx)
(xxxxx)
(xxxxx)
Specialized Equipment(Tailgates, flatbeds, etc): Access to a dock: YES Preferred Lanes: Preferred Lanes: Preferred Lanes:
NO
FUELTRANSPORT CARRIER PROFILE 4. CERTIFICATIONS
Please fill all those that Apply & Attach a copy of all applicable certificates: Cargo
General Liability
Other
Automobile
MC:
SCAC:
DOT:
ACE:
W-9:
FAST:
CTPAT:
DUNS: 5. TRADE REFRENCES
Company Name: Company Name: Company Name: Company Name: Company Name: Company Name:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
Phone:
Contact:
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
6. BROKER REFRENCES
Company Name: Company Name: Company Name: Company Name: Company Name: Company Name:
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
(xxx-xxx-xxxx)
FUELTRANSPORT CARRIER PROFILE 7. BANK INFORMATION
Name of Bank:
Bank Officer:
Address of Bank: Telephone No:
Fax.No:
(xxx-xxx-xxxx)
Please note that our payment terms are 30 days from invoice date, and we require an Original copy of the Shippers Bill of Lading signed by the receiver with no damages, shortages, or late delivery, together with a Copy of our load confirmation and your invoice. For immediate'processing and to ensure timely payment, we Accept electronic billing (via email or fax) Please send all your documents to:
Name(printed):
Signature:
Title:
Date:
(mm-dd-yyyy)
If you require any further information, please do not hesitate to contact us at 514 948 2225. Otherwise, please return this Form completed and signed VIA FAX 514 948 4441. We look forward to doing more business with you in the near future
CLEAR FORM
SAVE
PRINT
SAVE & EMAIL
FUELTRANSPORT CREDIT INFORMATION
Company Name: Fuel Transport Inc. Head Office Address: 2480 Rue Senkus, LaSalle, Quebec H8N2X9
Tel No.#: 514-375-3050 / 866-433-3835
Fax No.#: 514-948-4441 / 866-852-4765
Dun & Bradstreet #: 20-514-9250
Special Billing Instructions: Signed P.O.D., Carrier Confirmation and invoice required
Number of Years in business: 10
Owner Name: Robert Piccioni, President
Bank Reference: Name of Bank:
BMO Bank of Montreal CDN A/C # 0257-1043-457
Address
1299 Greene Avenue Westmount, QC H3Z 2A6
Contact
Linda Seniuk 514-848-0425 Fax No. 514-846-0853
USD #0267-4602-555
&
Patricia Careaga-Olaechea 514-846-3234 Fax No. 514-846-0853
FUELTRANSPORT CREDIT REFRENCES
Carrier: Delta Logistics 12201 Tecumsah road est Unit C Tecumseh, on N5N 1A9 Contact: Gabriel Tel. 519-915-8151 Montreal Cargo Express inc. 2380 46th Avenue Lachine, Quebec H8T 2P3 Contact: Roula Tel.: 514-636-8602 Sunrise 6-6150 HIGHWAY 7, UNIT #401 Woodbridge, ON L4H 0R6 Contact: Dave Tel.: 905-857-7666
Suppliers: PENSKE 2380 46th Avenue Lachine, Quebec H8T 2P3 Contact: Roula Tel.: 514-636-8602
Papeterie Les Entreprises 6-6150 HIGHWAY 7, UNIT #401 Woodbridge, ON L4H 0R6 Contact: Dave Tel.: 905-857-7666
FUELTRANSPORT US DEPARTMENT
US DEPARTMENT
FUELTRANSPORT STRATEGIC UNDERWRITING MANAGERS
FUELTRANSPORT NUMERO D’INTERMEDIARES EN SERVICES DE TRANSPORT
FUELTRANSPORT INSURANCE
FUELTRANSPORT INSURANCE
INSURANCE
