Agent Request Form

Complete this form to start the process of becoming an official Logistics Plus® freight agent.

Name(Required)

First Last

Company Name(Required)

Job Title/Area

Email(Required)

Phone(Required)

Area of Interest(Required)

Domestic Agency

International Agency

Address(Required)

City(Required)

State/Province(Required)

Zip/Postal Code(Required)

Country(Required)

Current Annualized Revenue(Required)

Additional Comments or Instructions

How did you learn about Logistics Plus

Confirmation

Name

This field is for validation purposes and should be left unchanged.