Bonnie Speed Registration Form

Need a
Bonnie Speed Account?
Apply here!

Registration

Company Name:
First Name:		Last Name:
Street Address:		City:
State:		Zip:
Day Phone:		Eve. Phone:
Fax No.:		E-mail:
Contact Name:		Password:
Do your deliveries require a PO#, Job#, or Client# to appear on your invoice? Yes No
Does your account have established special rates? Yes No
Type of Deliveries (check all that apply) ENV PKGS BXS SKIDS
Average # of Deliveries/Day:
Type of Service required: (check all that apply) Bonnie Plus Standard (1 hr. env/pkg delivery) (2 hr.env/pkg delivery) Routes Trucking (Daily schedules) (Freight up to 15,000 lbs.)
Number of users that will be accessing Bonnie Speed Website?
Company Name: Address: Company Name: Address: Company Name: Address: Company Name: Address: Company Name: Address:
Will you pay for service via credit card? Yes No
Card Type: Card No:
Exp. Date: Name on Card: