Customer Information Sheet

Fill this out from your phone or computer and tap Send to MTSi~DATS. It goes straight to Allison. Fields marked * are required.

Company Information

First name * Last name * Company name (dba) Mailing address (street or PO Box) * City * State * Zip *

Physical address is the same as mailing

Physical address Physical city State Zip County Inside / outside city limits FEIN SSN Driver's license # Contact person * Alt contact Phone number * Alt number Email address * Alt email address Fax number Cell number Name on cell

OK to text this cell phone? Yes No

Corporate Information

Type of company Corporation Partnership LLC Sole Proprietor

Corporate name State Partner or officer name Title Partner or officer name Title Partner or officer name Title Referred by Prior service company

Trucking Accounts

US DOT # MC # IRP account(s) IFTA account Name the FEIN is in Commodities hauled

Insurance Information

Insurance agency Phone Fax Street or PO Box City State Zip County

Services

Would you like MTSi to open your IFTA account? Yes No

Would you like MTSi to do your fuel tax reporting? Yes No

Would you like MTSi to do your quarterly reporting? KY NM NY OR

Beginning date Quarter Year

Rather use paper? Download the fillable PDF, fill it out and email it to allison.erwin@mtsidats.com, or print it and bring it by.