Customer Profile Form

Attention! Don't forget to read the contract.

Before proceeding, please take the time to review the contract by clicking on the link provided. The Customer Profile form will automatically fill in the contract, and by signing the form, you will be legally binding yourself to the terms outlined in the contract.

Customer Profile Form

General Transportation, Inc.
P.O. Box 1580
Van Buren, AR 72957
PH: (800) 245-4471 FX: (479) 471-1700

Customer Basic Information

Business Name *

Dunn & Bradstreet Number (DNB#)

Business Address *

Business Address

Contact Name *

Customer Contact Email *

Customer Phone *

Customer Fax

Customer Billing Information

Billing Contact Name *

Terms of Pay

Billing Address *

Billing Address

Credit References

optional, but would expedite approval of credit limits>

Files Upload

Contract Agreement

If you are human, leave this field blank.

Customer Profile Form

Customer Profile Form

Attention! Don't forget to read the contract.