New E-Vendor Request


* Did you start a request form and would like to continue? >>Click HERE<<
>> You have 20 minutes to fill out each section of the form otherwise the data will not be saved and the session will be terminated. <<
SERVICE PROVIDER DETAILS  
Company Name *
   

Street Address *     (No PO Boxes, RR etc.)
Fax Number:
( )   -
(Do not abbreviate)
City *   
   

State * 
ZIP * 
_______________________________________________________________________________________________
Remittance Address *     

City *   
    

    
State
ZIP *  
_______________________________________________________________________________________________
Federal Tax Id No.
Business License/Permit No.  
Liability Insurance Carrier

Liability Insurance Expiration Date
  
Note: U-Haul Int'l requires 'Certificate of Insurance Liability' (COI) on all repair/maintenance vendors.
_______________________________________________________________________________________________
Email Address *   
Password *       
Confirm Email Address  
Confirm Password  
  Password: 6 to 10 characters. Include at least
one number and one upper case character.
It must NOT contain a special character.
Do NOT use your email account password
Second Email Address (Not Required)   
_______________________________________________________________________________________________
Applicant First Name
Applicant Last Name
Applicant Title

Version: 1.0.8.0