Please complete all sections. Click the Submit button to continue. "*" indicates required fields UACL Logistics Credit RequestAgency Number* Agent Email* Line Of Credit Requested* Please Select if it is a one time load Load must be under $5,000 and will be expedited Overall Total or Additional?*-Select-Overall TotalAdditionalIs This For A Broker*- Select -YesNoMC #* Current Customer?*- Select -YesNoCustomer #* Business Name* Type of Business*-Select-UACL ContainerUACL TruckloadDoes the customer have a direct relationship with SSL?*-Select-YesNoCredit Check Requested ForBusiness Name* Phone*Address Line 1* Address Line 2 City* State/Province* Zip* A.P. Contact Name* A.P Contact Phone* A.P Contact Email* Billing InformationHow Do You Want to Receive Invoices?*MailEmailWeb BillInvoice E-mail Address* Is Invoicing Address the Same as Business?*YesNoAddress Line 1* Address Line 2 City* State* Zip* Please Provide Additional Web Bill Detail in CommentsEDI Capable?*- Select -YesNoEFT Capable?*- Select -YesNoAuto Pay?*- Select -YesNoLoad InformationLoad Revenue* Number Of Loads* Per*- Select -DayWeekMonthCommodity* Misc. Billing Requirements (Ref #, etc)/CommentsCAPTCHA
