Vendor Application

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* Denotes a required field.

Company Name *

Number of years in business *

First Name *

Last Name *

Address *

City *

State *

Zip *

Contact Name *

Phone *

Fax

Type of transportation moves you would like to do for Premier Trailer Leasing *

Freight Loads

Power Only

Both

Address

City

State

Zip

Accounts Receivable Phone *

Accounts Receivable Email

Accounts Receivable Fax

Payment Method

Federal Tax ID (FEIN, TIN, EIN, SSN)

Please attach a copy of W-9 with your response *

Commercial General Liability - 1M minimum for each occurrence
Automobile Liability - 1M Combined Single Limit
Premier Trailer Leasing listed as Additional Insured on CGL and Auto
Must have physical damage coverage on the certificate with the comp/col deductibles listed and we must be listed as the loss payee. We do not accept trailer interchange for physical damage coverage.
Worker's Comp

Attach certificate of insurance that meet the requirements above *

Vendor agrees to maintain and carry insurance coverage that meets Premier Trailer Leasing's requirements, as outlined above, at all times while performing work for Premier Trailer Leasing, Inc.
Payment terms are Net 10 from invoice date
Transportation Invoices need to include the following:
- Unit Numbers.
- Pick up location.
- Delivery location
- Date of unit pick up.
- Date of unit delivery.
- Address and name of facility.

Vendor hereby certifies that information furnished in this application is current and accurate.

Agree *

Authorized Applicant Name *

Date