Page 1 of 6Checklist ItemsPlease complete all information that pertains to you or your company. The better information we have, the better we will be able to assist you. This information may be updated at any time by notifying your dispatcher. This information is for our use only and will not be released to any third party without your permission. Contact names, social numbers and TAX ID/EIN Numbers ready Will need to upload documents Motor Carrier Authority Will need to also do this NextContact InfoCompany Name*Owner Name*Business Phone*Owner Email*Physical Address*NO PO BOXESCity*State*Please selectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip*ALT PhoneBackNextBusiness InfoCarrier Type*If you have you own DOT number we can dispatch under your authority. If you just have your own truck/trailer you can lease on to another carrier’s authorityI have my USDOT NumberI need to Lease on my Truck/TrailerDOT#*We will use the contact information on file with the FMCSA to verify account ownership# Of Trucks*Years Established# Drivers*Are you using a factoring company*YesNoFactor Name*Factor PhoneFactor EmailDo you dispatch your own loadsCompletely FREE service to find qkuality loads. We book freight with reliable paying brokers to ensure you make payment on your fuel spend.YesNoDispatcher Name*Dispatcher Phone*Dispatcher Email*Hazmat Cert#TWIC CardYESNOLegal StructurePlease selectPartnershipLimited Liability CompanySole ProprietorshipCurrently using a fuel card*YesNoFuel cards you are currently using*Please check all that applyPILOT/FJTA/PETROLOVESSAPP BROSAMBestRoad RangersEFS/EdgeTCSCardServicesAre you leasing trailers*YesNoELD Provider*Please selectSamsaraKeepTruckingOmniTrackseRoadBigRoadOtherEquipment Capacity Please list how man trailers of each type you have.Van Trailers# of Van trailers in fleetReefer Trailers# of Van trailers in fleetFlatbed Trailers# of Van trailers in fleetAuto Haulers# of Van trailers in fleetBackNextService Areas of OperationLane TypePlease selectOver The RoadWestern RegionalEastern RegionalSouthern RegionalMidwestern RegionalAre you willing to spend at least 2+ weeks OTR?*YESNOStatesALL STATESAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingBackNextUpload DocumentsDOT Authority*Insurance CertificateFactoring Notice of Assignment*W9 Formlink hereBackNextTerms of ServiceEffective: June 21, 2021IMPORTANT – CAREFULLY READ ALL THE TERMS AND CONDITIONS OF THIS AGREEMENT. BY SUBMITTING AN ORDER WITHI accept the terms of service agreement*YESBackSendThis field should be left blank
