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New Customer Set Up

Please fill out and submit to be setup as a Patriot Freight Group customer. Thank you.

New Customer Set Up

"*" indicates required fields

Email

This field is for validation purposes and should be left unchanged.

Basic Information

How did you hear about us?*

Google Search

Facebook

Instagram

Twitter

Other

Patriot Sales Representative*

Company Name*

Primary Contact*

First Last

Primary Email*

Primary Phone Number*

Shipping and Receiving Information

Answer the following questions concerning shipping and receiving requirement.

Where is your Shipping/Receiving location?*

United States of America

Canada

Mexico

Shipping/Receiving Address*

Street Address Address Line 2 City State ZIP Code

Shipping/Receiving Address*

Street Address Address Line 2 City Province Postal Code

Do you require appointments for shipping and receiving?*

Yes

No

Describe your shipping and receiving hours of operation*

(i.e. Monday thru Friday 8-5 and weekends by appointment)

Shipping/Receiving Contact*

First Last

Shipping/Receiving Email*

Shipping/Receiving Phone Number*

Accounting Information

Answer the following questions concerning accounting practices.

Do you accept electronic invoices?*

Yes

No

Do you require a copy of a signed bill of lading be submitted with the invoice?*

Yes

No

Please explain if you require any internal reference numbers to be listed on this invoice

(i.e. a purchase order # or sales order #)

Remit To*

United States of America

Canada

Remit To Address*

Street Address Address Line 2 City State ZIP Code

Remit To Address*

Street Address Address Line 2 City Province Postal Code

Accounts Payable Contact*

First Last

Accounts Payable Email*

Accounts Payable Phone Number*

Please Choose Requested Payment Method*

Credit Card – charged at time of booking

ACH/Wire – must be initiated prior to delivery, confirmation provided

Terms with Credit Line – must be requested prior to booking a load as initial review can take up to 2 business days

EIN (for credit review purposes)

DUNS # (for credit review purposes)

Trade References

Please provide at least 2 trade references for credit review purposes.

Trade Reference #1 Company Name*

Trade Reference #1 Contact Name

First Last

Trade Reference #1 Email

Trade Reference #1 Phone Number*

Trade Reference #1 Address

Street Address Address Line 2 City State ZIP Code

Trade Reference #1 Address

Street Address Address Line 2 City State ZIP Code

Trade Reference #2 Company Name*

Trade Reference #2 Contact Name

First Last

Trade Reference #2 Email

Trade Reference #2 Phone Number*

Trade Reference #2 Address

Street Address Address Line 2 City State ZIP Code

Banking Reference

Please provide at least 1 banking reference.

Banking Reference Company Name*

Banking Reference Contact Name

First Last

Banking Reference Email

Banking Reference Phone Number*

Banking Reference Address

Street Address Address Line 2 City State ZIP Code

Signature*

Name*

Title*

Authorization*

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Credit Check.

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IP Address*

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User Agent*

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Referer*

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Full Truckload
Hazmat
Hot Shot
Less Than Truckload
Over Dimensional / Heavy Haul
Personal Items

Full Truckload
Hazmat
Hot Shot
Less Than Truckload
Over Dimensional / Heavy Haul
Personal Items

Patriot Freight Group aims to relieve the stress commonly associated with the transportation of goods by exceeding the expectations of our customers and carriers; always striving to be the preferred logistics provider.

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Terms of Service
Privacy Policy

Terms of Service
Privacy Policy

Customers
Carriers
Request A Quote
Jobs
About Us
Contact Us

Customers
Carriers
Request A Quote
Jobs
About Us
Contact Us