Carrier Registration Form
The Truckers Brotherhood Inc supports Small Carriers survive and grow in this highly competitive industry. This is a Free Membership Program where Carriers can do business in a new and better way! The Truckers Brotherhood is happy to having you join The Brotherhood! Welcome to The Truckers Brotherhood!
Name
First Name
Last Name
Company Name
Employer Identification Number
US DOT Number
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Operational Information
I am
Please Select
a Small Carrier (1 - 5 power units)
a Mid-Size Carrier (5 - 25 power units)
Do you have ANY trailers?
Please Select
Yes, I own, rent or lease trailers
No, I do not have any trailers
I operate BOX TRUCKS
What type of trailers do you operate?
Please Select
I operate Power Only
Dry Vans
Reefers
Flatbeds
Boxtrucks
ELD/AOBRD compliance
Please Select
I use AOBRD/ELD in my truck
My truck is exempt
Who is your ELD/AOBRD provider?
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Do you accept Next Day Quick Pay for flat 3% rate?
Please Select
Yes, please set me up for QuickPay
No, I prefer to wait 30 days
Do you also have your own Factoring Company?
Please Select
Yes, I do.
No, I do not.
If you do have a Factoring Company, who is it?
If you're an Owner Operator without MC number, indicate N/A
Factoring Company's Address
If you're an Owner Operator without MC number, indicate N/A
Contact Name and email or phone
If you're an Owner Operator without MC number, indicate N/A
Please, attached a copy of Notice of Assignment Letter
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Do you use a fuel card?
Please Select
Yes, I do have my own fuel card
I use my own credit/debit cards
I do not have a fuel card
If you answered Yes, please choose below
Please Select
I pre-pay (pre-fill) my fuel card
I have a line of credit
Help me get a fuel card
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What's your Insurance Company name?
My company pays for
Please Select
$1,000,000 Liability Coverage
$750,000 Liability Coverage
My company has
Please Select
$100,000 Cargo
$250,000 Cargo or more
My company
Please Select
DOES have Trailer Interchange
DOES NOT have Trailer Interchange
Please, provide your Insurance Agent/Broker name
Please, provide your Insurance Agent/Broker phone
Please, provide your Insurance Agent/Broker email
Please, select the expiration date of your current insurance policy
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Operational documents
These documents are required to support Carrier's operations on a daily basis.
Please, upload the copy of your authority letter or a license.
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Please, upload the copy of your W-9 form
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Please, upload the copy of your Certificate of Insurance
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Please, upload the copy of your SCAC Code letter
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Copy of voided check to receive/make payments
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Submit
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