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Items with * are required.

Are you a Business or Individual?*
Company Name: *
Federal ID # or SS#: *
Company Website (Full URL with http or https):
Type of Business: *

Contact Details
First Name: *
Last Name: *
Phone (555-555-5555 x123): *
E-mail Address: *
Online Account Login Username: * (Letters & numbers only. Min 5 chars)
Password: *
Re-type Password: *

Physical Business Address
Street: * Suite / Unit #:
City: *
State: *
Zip: *
Common Caller's Name & Phone #
Phone (555-555-5555 x123)

Billing Information
First Name: *
Last Name: *
Email (Address invoices will be sent to. Separate multiple with commas. Max of three emails): *
Phone (555-555-5555 x123): *
Street: * Suite / Unit #:
City: *
State: *
Zip: *
Denver Boulder Couriers bills our customers on the last day of each month. All invoices are sent via email to the billing email(s) entered above, If you require paper statements mailed to you, please select either paper option below. A $4/month fee will be applied for paper statements.
Invoice Type: *

Do you require a reference, PO #, or Job Code for your deliveries for billing purposes? *

Describe the typical service you need:*

How often do you use a courier service?*

Are you currently using a courier service?*

What type of services do you need?
Small package, local delivery
Express Freight
Medical Services
Daily scheduled deliveries (mail, bank deposits, etc.)
Logistics analysis and consultation
Other (please describe in notes below)

How did you hear about us?: *
DBC Contacted Us
Referral From:
Social Media:
Google Search (Search term used):
Other - please describe:

Additional Notes / What are your needs?

Payment Terms: Net 15 days unless otherwise negotiated in writing.

Unless a greater value has been placed on a shipment at the time that a request for delivery is made to Denver Boulder Couriers, it is agreed that, in consideration of the rate being charged, the liability of Denver Boulder Couriers for damages to, or loss or delay of such shipment is limited to $100. If the shipper declares to Denver Boulder Couriers that the value of the shipment exceeds $100, Denver Boulder Couriers will furnish a rate which will provide insurance against the damage to, or loss or delay of the shipment at the higher value so declared by the shipper.

I have read and understand that failure to pay in accordance with the payment terms will result in a loss of service, and that I will be responsible for all Collection Costs and Expenses.

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