Services Portal > Customer Activities > Rapids Setup

*Indicates a Required Field.

Company:*

Duns #:

Fed. Tax Id:*

Address:*

State of Incorporation:*

Legal Entity Type:*

Primary Business Type:*

Business Contact Name:*

Business Contact Title:*

Business Phone:*

Business Cell:

Business Fax:

Business E-mail:*

Business address same as Company address.

Business Address:*

Credit Contact Name:*

Credit Contact Title:*

Credit Phone:*

Credit Cell:

Credit Fax:

Credit E-mail:*

Credit address same as Company address.

Credit Address:*

Invoice Contact Name:*

Invoice Contact Title:*

Invoice Phone:*

Invoice Cell:

Invoice Fax:

Invoice E-mail:*

Invoice address same as Company address.

Invoice Address:*

Primary Contact Name: (Individual who will be executing contracts)*

Primary Contact Title:*

Primary Phone:*

Primary Cell:

Primary Fax:

Primary E-mail:*

Primary address same as Company address.

Primary Address:*

Transportation Agreements: (Check all agreements you would like additional information on.)

Rapids Access	Pooling and Title Transfer Tracking
Interruptible Transportation	Firm Transportation
Agency Delegation	Trading Partner Agreement
Park and Loan

Credit Information:

Comments:

If you have any questions, please call our Hotline at (801) 937-6111