Carrier onboarding form

Thank you for your interest in working with Xcoldchain! We look forward to partnering with you. To get you set up, please fill in this form and upload the required documents. Fields marked * are required.

Questions? carriersetup@xcoldchain.com · 828-929-3865 ext. 2516

XCOLDCHAIN LLC MC# 1746673 xcoldchain.com

Contact

6. Contact name *

7. Phone *

8. Email *

9. Dispatch phone and email

Modes of transportation

10. Number of trucks *

11. Equipment type (select all that apply) *

Reefer Dry van Flatbed Step deck Box truck Sprinter van Cargo van

12. Type of service (select all that apply) *

Truckload (FTL) Less Than Truckload (LTL) Expedite Last Mile

Insurance

13. Insurance company name *

14. Upload Certificate of Insurance

Attach when returning this form

Certificate holder: XCOLDCHAIN LLC, 38 Thistle Ln, Fletcher, NC 28732-9488

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Billing details

15. Billing company name *

As shown on your W-9

16. Billing address *

Street, city, state, ZIP — PO Box is accepted

17. Company Tax ID (EIN) *

18. Billing contact name *

19. Billing contact phone *

20. Billing contact email *

21. Attach W-9 form

Attach when returning this form

Payment information

22. QuickPay *

Yes No

23. Do you use a factoring company? *

Yes No

24. Factoring company name

Complete only if you use a factoring company

25. Factoring company contact name, phone and email

26. Factoring payment / remittance instructions

27. Upload Notice of Assignment (NOA)

Attach when returning this form

Required if you use a factoring company

28. Preferred payment method

ACH Wire Check

29. Payee / account holder name

30. Bank name

31. Bank address

32. Routing number

33. Account number

34. Account type

Checking Savings

35. Remittance email

Signature

36. Name and title *

37. Signature *

38. Date *

39. I confirm the information above is correct. *

I agree

Thank you! Our carrier team will review your information and contact you shortly.

Company fax

XCOLDCHAIN LLC · Carrier onboarding form · MC# 1746673 carriersetup@xcoldchain.com · 828-929-3865 ext. 2516 2 / 2

Carrier onboarding form

Company information

Contact

Modes of transportation

Insurance

Billing details

Payment information

Signature

Form received