New Client Questionnaire

Phone: (616)735-1500 Toll Free: (888)269-4743 Fax: (616)735-3950

1950 Waldorf NW, Ste C, Walker, MI 49544
New Client Questionnaire
The following information is needed to complete

Federal & State applications and forms.
Company Information:
LEGAL Name
DBA Name
Contact Person

First NameLast Name
Address

Physical Address

Street Address Line 2

CityState

Zip Code
Company Phone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Email Address
example@example.com
Other Contact #'s
Mailing Address (if different from above):

Address

Street Address Line 2

City State

Zip Code
Authority Type

Please Enter the Number of Drivers in Each Category:

Total Drivers
Total CDL Drivers
Please List All Drivers

(Type Them Here or Attach a List Below If More Than Four)

Please Type Driver List Below:

Please Enter the Number of Vehicles in Each Category:

Please List All Trucks

(Type Them Here or Attach a List Below If More Than Four)

Please List Each Vehicle Below:

*Note: List the exact GVWR as indicated on the door tag on the driver's side door frame
Attach Driver and/or Truck List Here

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Provide Information on All Accidents in the Last 12 Months

(Either Attach a List or List Them Here)
Location
Driver's Names
Number of Injuries
Number of Fatalities
Number of Vehicles Towed

Please Provide WT Fleet Services With Copies of The Following Items:

If you cannot upload them, please check below to indicate how they will be delivered to WT Fleet Services and any other explanation needed.
If you are unable to upload any of the items below, please indicate how they will be delivered to us:

Other
Articles of Incorporation, Organization or DBA Certificate

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Liability Insurance

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Title for each Truck & Trailer

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Registration for each Truck (Please provide Unit#'s for each unit)

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Annual Inspections for all Commercial Motor Vehicles and Trailers

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Heavy Vehicle Use Tax (Form 2290) for Each Truck Over 54,000 pounds

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ANY Certificates of Authority Currently Held

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Owners Drivers License

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WT Fleet Services can set up your company with Drug Screens Plus, as a courtesy to you.
Would you like WT Fleet Services to do this?
Proof of Enrollment in a Drug Testing Program, if applicable

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Any Additional Information We Should Know About You or Your Company?
Any Additional Files or Photos That We Need? Please Upload Them Here:

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Date Submitted

MonthDayYear
Please verify that you are a human
Should be Empty:

Company Information: