Carrier Application Form
Application Date
-
Month
-
Day
Year
Date
Carrier Profile
Company Name
Entity Type
Founded Date
-
Month
-
Day
Year
Date
US DOT #
MC #
Company Phone Number
Please enter a valid phone number.
Company Email
example@example.com
Company Website
Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are the services offered?
Truckload, expedite, brokerage, air freight
What are the available equipment, tools, machines, etc.?
Dry van, flatbed, straight trucks, reefer
Contact Person Name
First Name
Last Name
Contact Person Job Title
Contact Person Phone Number
Please enter a valid phone number.
Contact Person Email Address
example@example.com
How many trucks does the company have?
Numbers
Remarks
How many trucks?
How many straight?
How many trailers?
How many trucks are on rent or lease?
Numbers
Remarks
How many trucks?
How many straight?
How many trailers?
Does the trucks have the company logo at the back?
Yes
No
How many employees do you have?
Numbers
Remarks
How many employees?
How many full-time employees?
How many contractual employees?
Does your company have a storage facility?
Yes
No
Is it temporary or permanent?
Temporary
Permanent
Does your company provide shippers additional insurance?
Yes
No
What type of insurance do you offer?
Do you belong to any registered moving associations or moving clubs?
Yes
No
Do you hire another companies (transportation/subcontractors) for deliveries?
Yes
No
Information about the third party companies
Company Name
Company Type
Company Phone
Company Email
Company DOT #
1
2
3
4
Please upload the following documents: W9/W8, Signed non-disclosure agreement, signed contract, insurance certificate, birth certificate, and other supporting documents
Browse Files
Drag and drop files here
Choose a file
Accepted file types: pdf, doc, png, jpg
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of
Please upload the following documents: Tariff, Arbitration Policy, Loss/Damage Claim Form
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Was there any previous history about your license being revoked?
Yes
No
Please provide more details about that situation
Revoked date, reason, and date reinstated
Authorized Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: