Carrier Registration Form
The Truckers Brotherhood Inc supports Small Carriers survive and grow in this highly competitive industry. Annual Membership Fee of $299.99 is due if you decide to join The Truckers Brotherhood. The Membership Fee can be refunded for whatever reason within 14 days. There is no cancellation or refund after the expiration of that period. Upon submission of your completed form, you will receive an invoice via email with instructions to submit payments. 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
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Operational Information
I am
a Small Carrier (1 - 5 power units)
a Mid-Size Carrier (5 - 25 power units)
Do you have ANY trailers?
Yes, I own, rent or lease trailers
No, I do not have any trailers
What type of trailers do you operate?
I operate Power Only
Dry Vans
Reefers
Flatbeds
ELD/AOBRD compliance
I use AOBRD/ELD in my truck
My truck is exempt
Who is your ELD/AOBRD provider?
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Do you CURRENTLY use Factoring services?
I am Owner Operator, no I do not
I am a Carrier, I do not factor
Yes, I do factor my freight bills
Who is your Factoring Company?
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?
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
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
$1,000,000 Liability Coverage
$750,000 Liability Coverage
My company has
$100,000 Cargo
$250,000 Cargo or more
My company
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
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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