Reliable Delivery
New Account Set-Up Form

Company Name*

Name of Company Needing Service
Delivery Services Contact Person*
Prefix First Last
Person Responsible for Shipping and Delivery Services
Company Address*
Street Address Address Line 2 City State ZIP Code
How Did You Hear About Us?*
Salesperson Who Assisted You*

If You Weren't Assisted, Please Type "N/A"
Telephone*
Direct Line or Extension (Please)
Shipping Department's Email Address*

Email Address for Shipping Department or Person Responsible for Shipping at Your Company
Preferred method for receiving invoices*
- Email
- Paper Invoice
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Contact*

Full Name of Person Responsible for Invoice Payment(s)
Billing Phone Number*
Direct Line or Extension is Preferred
Billing Email(s)*

Email Address Where Invoices and Inquiries Would be Sent
Employer Identification Number (EIN)*

Your Company's Tax Identification Code
Expected Number of Shipments (Monthly)*
Any special paperwork requirements (BOL, POD, etc.)?*
- Yes
- No
If "Yes", Please Explain Your Special Paperwork Requirements
- Yes, I Agree That if We Require Paperwork to be Returned, We Will be Placed on a Weekly Invoice Cycle in Which Paperwork Will be Mailed Back at That Time.
*Payment Term Expectations; Invoices are due and payable within 30 days from the invoice date. All invoices shall be deemed accurate unless Customer advises Reliable in writing of a pricing error within 10 days following receipt of the invoice. If Customer advises Reliable of a pricing error, (i) any amounts corrected by Reliable in writing shall be paid within 14 days of correction and (ii) all other amounts shall be paid by Customer by the due date. Customer may not offset, defer or deduct any invoiced amounts that Reliable determines are not erroneous following the notification process set forth above. Reliable, without waiving any other rights or remedies and without liability to Customer, may refuse additional orders for delivery until all overdue amounts are paid in full. Reliable shall be entitled to all reasonable legal and attorney fees and associated costs of collecting overdue amounts. If in Reliable’s sole judgment Customer's financial condition does not justify the terms of payment specified herein, Reliable may cancel this contract unless Customer shall immediately pay for all services which have been performed as invoiced.*
- Yes, I agree to the *Payment Term Expectations (Payment Terms: "NET 30")
*Payment Term Expectations; Invoices are due and payable within 30 days from the invoice date. All invoices shall be deemed accurate unless Customer advises Reliable in writing of a pricing error within 10 days following receipt of the invoice. If Customer advises Reliable of a pricing error, (i) any amounts corrected by Reliable in writing shall be paid within 14 days of correction and (ii) all other amounts shall be paid by Customer by the due date. Customer may not offset, defer or deduct any invoiced amounts that Reliable determines are not erroneous following the notification process set forth above. Reliable, without waiving any other rights or remedies and without liability to Customer, may refuse additional orders for delivery until all overdue amounts are paid in full. Reliable shall be entitled to all reasonable legal and attorney fees and associated costs of collecting overdue amounts. If in Reliable’s sole judgment Customer's financial condition does not justify the terms of payment specified herein, Reliable may cancel this contract unless Customer shall immediately pay for all services which have been performed as invoiced.
Trade Reference #1

Business Name of Reference
Contact Person at Business
First Last
Contact Person at Business
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Trade Reference #2

Business Name of Reference
Contact Person at Business
First Last
Contact Person at Business
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Trade Reference #3

Business Name of Reference
Contact Person at Business
First Last
Contact Person at Business
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
*
- I understand that checking this box constitutes a legal signature confirming that the above information is correct.
Your Name*

Name (First, Last ) of Person Submitting Form
Your Title*

Position of Person Submitting Form
Your Email Address*

Company Email Addresses Only (Please)

We Have The Shipping Solution
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Reliable Delivery New Account Set-Up Form

We Have The Shipping Solution To Your Logistics Problems.

Reliable Delivery
New Account Set-Up Form

We Have The Shipping Solution
To Your Logistics Problems.