DSTRILOGIX manages 5 data types including driver carrier assignments. Helps you organize, track, and share your work in 1 place for teams and solo users.

Shipper / Customer Account Application

Used by shippers or customers to request account setup, credit terms, and portal access by providing company details, shipping requirements, and financial references.

Full Name*

Phone Number*

Email Address*

Company and Contact

Legal Company Name*

DBA

Primary Contact*

Title

Email*

Phone*

Physical Address*

City*

State*

ZIP*

Billing Contact

Billing Email

Billing Phone

Billing Address if different

EIN - Restricted*

Industry / Commodity*

Shipping Profile

Equipment: Dry Van

I agree

Equipment: Reefer

I agree

Equipment: Flatbed

I agree

Equipment: Power Only

I agree

Equipment: Other

I agree

Typical Origin Regions*

Typical Destination Regions*

Estimated Loads Per Month*

Typical Weight*

Special Requirements

Credit and Billing

Requested Credit Limit*

Requested Payment Terms*

Purchase Order Required?*

Yes

Trade Reference 1

Trade Reference 1: Contact

Trade Reference 1: Phone / Email

Trade Reference 2

Trade Reference 2: Contact

Trade Reference 2: Phone / Email

W-9 Attached

I agree

W-9 Upload / Received Date

Credit references or credit application support attached

I agree

Credit references Upload / Received Date

Service agreement when approved attached

I agree

Service agreement Upload / Received Date

Certification

Authorized Representative*

Signature*

By typing your name, you are electronically signing this document.

Date*