E-Forms for Customers

Headquarter Address

Parent Company Address

Individual responsible for payment of freight charges

Login Multimodal's preferred invoicing method is via email unless otherwise noted. (All paper invoices may be charged a $2.00 processing fee for any excessive or duplicates required.)

Person Completing Credit Application

Submission of this electronic application shall have the same force and effect as if the application bore an inked original signature. The submitter certifies that all information provided is true, correct and complete and that the account will be used solely for business and commercial purposes. The applicant, or the person submitting this application if not the applicant, hereby represents and warrants that the applicant(s), owner(s) and guarantor(s) (if any) have expressly authorized (i) the submission of this application and (ii) Login Multimodal, LLc. or its designees or assignees to obtain information about them from any business or consumer reporting agency or other sources that provide credit reports, account history information, credit and employment history or similar information and such authorization shall extend to obtaining updated information from time to time for purposes of reviewing or collecting the account. The applicant acknowledges that, based upon such information and other factors which may apply, Login Multimodal, LLc. or its assignees or designees, in their sole discretion, may either grant or decline to grant credit. By submitting this electronic application, the applicant agrees to receive updates from Login Multimodal, LLC. and its partners regarding this account via the telephone or fax numbers, or email address, provided for the account above. If the applicant has provided a mobile device number, applicant expressly agrees to receive communications at that number from Login Multimodal, LLC. and its authorized agents.