UACL Logistics Credit RequestAgency Number*Agent Email* Line Of Credit Requested*Is This For A Broker*- Select -YesNoMC #*Current Customer?*- Select -YesNoCustomer #*Business Name*Credit Check Requested ForBusiness Name*Phone*Address Line 1*Address Line 2City*State/Province*Zip*A.P. Contact*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 2City*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*CommentsCAPTCHA
