Business Information
Owners Name
*
First Name
Middle Name
Last Name
Business Name
*
D/B/A (if different)
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Type of transportation services performed
Straight Truck
Tractor/Trailer
Tractor Only
Cargo Van / Last Mile
FORM OF BUSINESS
Sole Proprietorship
Corporation
Limited Liability Company
General Partnership
Limited Liability Partnership
OPERATING AUTHORITY
U.S. DOT No.
*
Motor Carrier Authority Number
*
Fleet
Total fleet size (include all vehicles):
Vehicle type
Rows
Total
Under 10,000 GVW (VAN)
GVW - 10,001-26,000 (Straight Truck)
GVW 26,001 and up (Tractor)
Total trailers (If applicable)
Rows
28 feet
53 feet
Total
Insurance Coverage
Vehicle Insurance – Minimum $1 Million (Minimum Requirment)
Cargo Insurance: Minimum 100,000 (Minimum Requirment)
General Liability Ins. – Minimum $1 Million (Minimum Requirment)
Workers’ Compensation Coverage
PERSONNEL
*
Rows
W2 Employees
1099 Contractors
Number of Drivers or sub-contractors as part of your current operation
Please check all locations in which you would like to be considered to provide services
*
ATL
BOS
BFI
CLE
DFW
CVG
DTW
EWR
MDW
LAX
JAX
PDX
MCI
BUF
COM
ONT- CA
STK- CA
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