New Carrier Setup New Carrier Setup Please enable JavaScript in your browser to complete this form. - Step 1 of 4LayoutCompany Name * DBA (if any)CountryUSCanadaAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCanada AddressAddress *CityProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal CodeLayoutPhone *MC# *FEIN/SSN *Number of Drivers?Do you factor your invoices? *YesNoEmail * USDOT# *Number of Trucks?Type Of Equipment?Dry VanReeferFlatbedConestogaNextFACTORING INFORMATION If you use a factoring service, please provide us the following information. This will ensure that we only use brokers that are approved by your factoring company. FACTORING COMPANY NAMECONTACT *FirstLastPhoneFaxWEBSITEFactoring CountryUSCanadaFactoring: US AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFactoring: Canada AddressFactoring: Canada Address *CityProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal CodeNextINSURANCE INFORMATION Please note: We do require our carriers to maintain a minimum of $1 Million in liability and $100,000.00 in Cargo insurance. INSURANCE COMPANYCONTACT *FirstLastPhoneFAXInsurance AddressUSCanadaBILLING: US ADDRESS (Insurance)Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeInsurance: Canada AddressInsurance: Canada Address *CityProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal CodeNextWhat States/Provinces Do You Prefer To Drive? Prefered States *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPrefered ProvincesAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonUpload MC Authority Letter, Certificate Of Liability Insurance, W9 Click or drag files to this area to upload. You can upload up to 5 files. Max. file size: 256 MB.Submit Dispatcher Carrier Profile Please enable JavaScript in your browser to complete this form.PART I: CARRIER PROFILE INFORMATION SECTION: - Step 1 of 3COMPANYD/B/A (IF Any)PHYSICAL ADDRESS (MAILING ADDRESS)AddressCityZIP/Postal CodeState/ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonCountryCanadaUSAMAIN CONTACT: *FirstLastOFFICE PHONEFAXCELLEMERGENCY CONTACT *FirstLastEMERGENCY CONTACT PHONEEmail *WEBSITE (IF ANY)DOT#MC#SSN/EIN# SCACCODETWIG CERTIFIEDYESNOHAZ MAT CERTIFIEDYESNONextPART 2: EQUIPMENT SECTION (For more than one truck use the multiple truck form) Checkboxes48' VAN53' VANAIRRIDEVENTEDE-TRACKLOGISTICSLOAD BARSSTRAPSPADSMAX LOAD WEIGHTCOMMENTSCarrier ProfileREEFER EQUIPMENT48' REF53'REFAIRRIDEPALLETSETRACKLOAD BARSFLATBED/SPECIALIZED EQUIPMENT45' FLAT48' REF53' REF 48' STEP DECK53' STEP DECKRGNIF SO SIZERAMPSLEVELERSCHAINSSTRAPSEXTRA FLATBED EQUIPMENTTARPSSIDESOVERSIZEMAX LOAD WEIGHTCOMMENTSNextPART 3: SERVICE AREAS OF OPERATION (Check all that apply) United StatesALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYCanadaABBCSKMBONQCMexicoMXRate of Haul Information:Please give us your minimum rate information. We understand that many factors will change this information. But this will give us a starting point. MINIMUM RATE PER MILE: MAX PICKS: MAX DROPS: COST PER EXTRA STOP: DRIVER TOUCH: YesNoCOMMENTS:OTHER INFORMATIONPLEASE USE THE FOLLOWING SECTION TO BETTER DESCRIBE YOUR COMPANY THAT WE HAVE NOT ALREADY ASKED (For Office Use Only)MULTIPLE TRUCK OPERATION FORMPlease complete this form if you are a trucking company with more than one (1) truck working under your authority.TRUCK# (1)TRAILER# (1)TYPE TRLR (1)MAX WGHT (1)DRIVER (1)CELL (1)TRUCK# (2)TRAILER# (2)TYPE TRLR (2)MAX WGHT (2)DRIVER (2)CELL (2)TRUCK# (3)TRAILER# (3)TYPE TRLR (3)MAX WGHT (3)DRIVER (3)CELL (3)Submit