New Customer Info Form | Flotrans2021

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New Customer Information Form

Business Information

Flo Contact/Salesperson

Legal Company Name

Address

City

State

Zip Code

Phone Number

Tax ID Number

Type of Business

AP Contact

Fax Number

Type of Entity

In Business Since

Email

AP Contact Phone

Documents Needed for Invoicing:

Banking Information

Name of Bank:

Bank Address

Bank State

Phone

Contact Name

Bank City

Bank Zip Code

Fax

Email

Account(s):

Trade References

1

Company

Address

State (Reference 1)

Phone

Contact Name

City (Reference 1)

Zip Code (Reference 1)

Fax

Email

2

Company

Address

State (Reference 2)

Phone

Contact Name

City (Reference 2)

Zip Code (Reference 2)

Fax

Email

Applicant Printed Name

Title

Today's Date

Thanks for submitting! Your account representative will be in touch soon. Your confirmation code is FLO2022.

Office: 708-929-4431 Fax: 708-929-4436
5575 S. Archer Ave., Chicago, IL 60638

Copyright © FLO Trans. All rights reserved.

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