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EFS Transportation Services, Inc.
2525 Horizon Lake Drive, Suite 120
Memphis , TN 38133

 
FTP Authorization Form  

Trucking Company Information
Date    
Account Number   
Company Name   
Contact Person   
Contact Email   
Phone Number   
Fax Number   
Address   
City, State & Zip   

This form serves as formal authorization to EFS Transportation Services (EFSTS) to transmit, on a daily basis, all transaction data processed at EFS-affiliated locations pursuant to the EFS Customer Agreement. EFS Customer, for itself and for its parent companies, subsidiaries, affiliates, successors, representatives, agents, employees, partners and assigns ("Releasors"), hereby releases and forever discharges EFSTS, it affiliates, subsidiaries, successors, representatives, agents, employees and assigns ("Releasees"), from any and all claims, liabilities, actions, demands and damages, whatsoever, in law or in equity, that Releasors may hereafter have in any manner relating directly or indirectly to Transmission initiated by a third party, including without limitation, any EFS-affiliate location, cardholder, or any claim arising out of or relating to actions taken by Releasees in accordance with or in reliance upon information or instructions provided by Releasor or any other third party.

Authorized Signature   
Print Name    

Check all that apply:

EFS Formats:
Standard Fuel (ocs056)   
Comma-delimited fuel (ocs058)   
Standard TransCheck (usr056)   
Truck stop data (tcs506)   
Truck stop prices (tcs.dat)   

Third Party Formats
McLeod format (ocs056) 
 
Innovative format (ars122) 
 
Prophesy format (ocs058) 
 
Other 
 
Effective Date: 
 

Upon completion email or fax to:

softwaresupportmemphis@concordefs.com
Fax 901-380-8336

Questions call 866-841-9315 ext. 16776