Account Application | Diamond Line Delivery

"*" indicates required fields

Billing Information

BILL TO NAME (IF DIFFERENT FROM ABOVE)

BILLING ADDRESS*

CITY*

STATE*

ZIP CODE*

Shipping Information

SHIPPING LOCATION (IF DIFFERENT FROM ABOVE)

SHIPPING CONTACT PHONE NUMBER*

SHIPPING CONTACT EMAIL*

Business & Financial Details

STATE OF INCORPORATION

FEDERAL ID NUMBER*

YEARS IN BUSINESS*

HAVE YOU FILED FOR BANKRUPTCY?*

Yes

REQUESTED CREDIT LIMIT*

Invoicing & Payables

EMAIL FOR INVOICING*

WHAT BACKUP DOCUMENTS DO YOU WANT TO BE SENT WITH YOUR INVOICES?*

ARE E PROS NEEDED?*

This is common when using a third party TMS Provider like MyCarrier or Kuebix.

Yes

PAYABLES CONTACT NAME*

PAYABLES CONTACT EMAIL*

PAYABLES CONTACT PHONE*

AGING REPORT RECIPIENT (IF DIFFERENT FROM PAYABLES)

Account & Referral

DIAMOND LINE DELIVERY ACCOUNT EXECUTIVE

HOW DID YOU HEAR ABOUT US?

By submitting this application, I certify that all information provided is accurate and complete. I authorize Diamond Line Delivery Inc. to obtain credit information and contact trade references listed above. I agree to Diamond Line’s tariff rates and terms, available at dlds.com/resources.