LB Safety Operations Services, Inc.
931-657-5667 Fax 931-657-5668
KYU Number Application Order Form
Company Name:
Address:
City: State: Zip:
Phone: Fax:
Email: FEIN:
MC #: DOT#: IFTA TAX #:
Contact Name: Title:
Vehicle Year: Make
Vin # Unit # Gross Weight
Payment Method: Payment made Online Will Call with CC Info. Please call for CC Info.
I would like a free quote for receiving up to 95% advances within 24hours on your freight invoices with no contract terms, no application fees, no startup fees, unlimited credit checks, On-line account access, and more?: Yes No
KYU Number Application Charge will be $35.00, no extra charge for additional vehicles. Credit card payment will be required and can be made online or by phone, unless you have made prior billing arrangements with our company.
Signature Date
Please Print, Sign And FAX 931-657-5668 **KYU Numbers can take up to 24 business hours to process**