dynamic-content-widget-58351af-0ac34b1 - DLVRD

COMMENÇONS PAR UN COMPTE GRATUIT

COMMENÇONS PAR UN COMPTE GRATUIT

FR - COMMENCER - CTA (#10)

Prénom*

Nom*

Phone number*

Courriel*

Company name*

Dropdown

Comment avez-vous entendu parler de nous?*

Message*

LET'S START WITH A FREE ACCOUNT

New Account Form V2

Which service category are you interested in?

COMPANY DETAILS

Company Legal Name*

DBA (Name the company is doing business as)*

Address Line 1

Address Line 2

City

Zip or Postal Code

State or Province

Country

First Name*

Last Name*

Tel*

E-mail Address*

BILLING ADDRESS

Same as company details

Same as company details

Address Line 1

Address Line 2

City

Zip or Postal Code

State or Province

Country

First Name

Last Name

Tel

E-mail Address

Preferred Payment Method(s) :

Credit Card

EFT

Cheque

Required Credit Limit

I agree to DLVRD's payment terms and conditions

I agree to DLVRD's payment terms and conditions

Do you require an appointment?

Yes

No

Any pertinent detail

INVOICING CONTACT

Which e-mail addresses to send invoices to?

Is proof of delivery (POD) required?

Yes

No

Is there a client reference number required on the invoices?

Yes

No

SHIPPING/RECEIVING DETAILS

Same as company details

Same as company details

Address Line 1

Address Line 2

City

Zip or Postal Code

State or Province

Country

First Name

First Name

Tel

E-mail Address

Business Hours

Type of Commodity being shipped

Dock Available :

Yes

No

Liftgate required :

Yes

No

Location accessible by 53 foot truck :

Yes

No

Do you require an appointment?

Yes

No

Any pertinent detail

REFERENCES

Please provide at least one trade reference (ex.: Company Name, Address, Contact, Telephone, E-mail)

Reference #1 - Please specify

Reference #2 - Please specify

Reference #3 - Please specify

FOR INTERNATIONAL SHIPMENTS

Customs broker company name

Address Line 1

Address Line 2

City

Zip or Postal Code

State or Province

Country

First Name

First Name

Tel

E-mail Address

Account number (if applicable)

WHERE DID YOU HEAR ABOUT US?

Other (please specify)

Would you like to receive marketing emails from DLVRD? You can unsubscribe from our email list at any time.

Yes

No

I filled out this form on someone's behalf. DLVRD will confirm newsletter consent by sending an email to the email address provided above.

Ignore this field - See attached text file

COMMENÇONS PAR UN COMPTE GRATUIT

FR - COMMENCER - CTA (#10)

Prénom*

Nom*

Phone number*

Courriel*

Company name*

Dropdown

Comment avez-vous entendu parler de nous?*

Message*