State of Texas Account Information Request Form - Please use this page to request a new Central Freight Lines Account.

* = Required information
1. Agency Information
Select Agency* by name
or by ID
or Co-Op by name
or by ID
2. Pickup and Delivery
Company Name*  
Address*  
City*    ST*   Zip*     
List any additional locations required
Please supply address,phone number, fax number and contact name for each additional location
Does customer ship under an alias? If YES, please supply alias information
Is a third party account number required? If YES, please supply third party address
3. Billing Check here if billing address is the same as the pickup and delivery address
Address*  
City*    ST*   Zip*     
Do both prepaid and collect bills bill to the sames address? If NO, please supply the correct billing information
Billing Contact  Email   
Phone    Fax   
Do all divisions use the same billing address? If NO, please supply any different billing addresses
4. Documentation Required for Billing
check all that apply
5. Home Office Information
Address
City  ST   Zip   
Home Office Contact  Email   
Phone    Fax   
Type of business
How long in business  Dunn and Bradstreet Number 
Credit reference sheet available?
Approximate monthly shipping revenue or number of shipments per month
6. EDI - if required, please provide contact information
EDI Contact  Email   
Phone    Fax   
7. Reporting and Online Access
check all that are needed
List any other reporting requirements
For online access (eCentral), enter requested username  Email   
8. Payment - Any Information Needed from Central Freight Lines to Ensure Prompt Payment
check all that apply

For ACH, please fax Direct Deposit Form to Accounts Receivable at 254-741-5252
Payment Contact Person  Email   
Phone    Fax