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Contact Name

Email

Phone Number

DOT Number

NAICS Number

Business Size

Taxpayer ID

If you are diverse-owned, do you have a certification?

Disability:IN

NaVOBA: National Veteran Owned Business Association

NCBDC: National Veteran Business Development Council

NGLCC: National LGBT Chamber of Commerce

NMSDC: National Minority Supplier Development Council

SBA: Small Business Administration

WBENC: Women’s Business Enterprise National Council

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Supplier Signature

Consultant

Payment Terms

Sales Contact

Sales Email

XPO Customer Number

Address

Remit Address

DUNS Number

Fax Number

Parent Company

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