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LB Safety Operations Services, Inc. 931-657-5667 KYU Number Application Order Form Company Name: Address: City: State: Zip: Phone: Fax: Email: FEIN: MC #: DOT#: Contact Name: Title: Vehicle Year: Make Vin # Unit # Gross Weight Vehicle Year: Make Vin # Unit # Gross Weight Vehicle Year: Make Vin # Unit # Gross Weight Payment Method: Payment made Online Will Call with CC Info. Please call for CC Info. I would like a free quote for receiving up to 95% advances within 24hours on your freight invoices with no contract terms, no application fees, no startup fees, unlimited credit checks, On-line account access, and more?: Yes No KYU Number Application Charge will be $35.00, no extra charge for additional vehicles. Credit card payment will be required and can be made online or by phone, unless you have made prior billing arrangements with our company.
Signature Date Please Print, Sign And FAX 931-657-5668 *KYU Numbers can take up to 24 business hours to process* |