New Accounts / Application and Rate Confirmations.

Please complete the following form for a New Account Application & Rate-Confirmation.  If you have any questions, please reach out to our office at: 318-432-4270.    Please click ﻿HERE﻿ to go back to home page.﻿

New Application / Rate Confirmation

Company Name

Company Phone Number

Contact Name

Contact Phone Number if different from above

Email address for where invoice to be sent to

Contact Email Address if different from billing

Billing Address

MC/ICC#

US DOT #

EIN/TIN

Please check ALL boxes to acknowledge the following rates

Lead-Chase $1.85 per mile (300 minimum miles per day)

Lead-Chase Superload $1.95 per mile (300 minimum miles per day) Superloads classified as any load 16' wide or wider, 16' tall or taller, 120' long or longer.

High Pole $2.25 per mile (300 minimum miles per day)

Steerman $2.25 per mile (300 minimum miles per day)

No-Go $250.00 per day

Overnight $100 per night (in addition to No-Go if a No-Go is billed)

Fuel Surcharge: there will be a 15% per mile surcharge for miles in the following states: AZ, CA, IL, NV, NY, OR, PA, WA

Account to be set up on Net-30 terms. There is a 20% late fee on all invoices beyond 35 days.

Additional Information

Full Name

By entering your FULL NAME here and clicking SEND, you verify that all information provided above is correct. You agree to Coast 2 Coast Escorts to complete a Business Credit Check (Individual Consumer Check if an individual).

New Accounts / Application and Rate Confirmations.

New Application / Rate Confirmation

Thank you!

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