Provider Information Form - Carrier Management System

Your Trading Name

If you require multiple Providers, you will need to submit a new form for each Provider.

Company Name

Registered Address

Post Code

Telephone Number

Shipping Location

Depot/Location Address

Depot Manager

Email

Account Name

Account Number

IT Contact Name

IT Contact Phone

IT Contact Email

Sales Contact Name

Sales Contact Phone

Sales Contact Email

Additional Account Notes or Shipping Restrictions

Use the drop-down to select the Provider You wish to Use

User Name

Password

User Name

Password

From

To

Collecting Depot Number

Collecting Depot Name

Collecting Depot Phone Number

Contract number

Meter Number

Schedule Number

User Name

Password

Please check you have permission from the bill payer to use these accounts.

Should you have multiple locations/depots, please fill in one form for each.

Regards,
CloudStuff Team

This document must be signed and dated correctly for your activation to be successful.

(Sign with your mouse cursor, or use your finger if you're on a mobile device)

Print Name

Job Title / Position

Today's Date