FusionNetwork Registration

Company Information
Please provide the following information about your company.
Company Name:*
US DOT:
Authority (MC/FF):
Federal Tax ID:
SCAC:
C-TPAT Certification:
Safety Rating:
Minority Certified?
MWBE Type:
MWBE Expiration:
Date Format: MM slash DD slash YYYY
HazMat Certified?
* Indicates required fields.
Address
Please provide the physical address where your company is located and the remit-to address (If different).
Physical Address:*
Company Name Address City State / Province Postal Code Country
Mailing/Remit Address:
(Payment Remit to Address / Factoring Company Address)

Same as Physical Address

Company Name Address City State / Province Postal Code Country
* Indicates required fields.

Contact Information
Please provide a complete list of contacts. Please include after-hours contacts. (Click the plus (+) symbol to add additional contacts.)
Operations
Full Name Title Office Ext Fax Mobile Email

Up to 5 contacts.
Accounting
Full Name Title Office Ext Fax Mobile Email

Up to 5 contacts.
Sales
Full Name Title Office Ext Fax Mobile Email

Up to 5 contacts.
Notifications Emails*
Please indicate the email address or group where Logico should send the following notifications.
Load Tenders Freight Bids
EDI Capable?*
Logico's EDI specifications are available to download from our website.

Company Information

Full Name	Title	Office	Ext	Fax	Mobile	Email

Full Name	Title	Office	Ext	Fax	Mobile	Email

Full Name	Title	Office	Ext	Fax	Mobile	Email