Carrier Onboarding Form

Instructions: Please complete this form giving us all the information that pertains to you and your company. The better informed we are, the better we will be able to assist you. This form can be updated at any time by notifying us. This information is for our use only and will not be released to any third party without your express written permission.

PART I: CARRIER PROFILE INFORMATION SECTION:

COMPANY:

D/B/A (IF ANY)

MAIN CONTACT*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

OFFICE PHONE:

Area CodePhone Number

FAX:

Area CodePhone Number

CELL:*

Area CodePhone Number

EMERGENCY CONTACT:*

First NameLast Name

EMERGENCY CONTACT PHONE NUMBER*

Area CodePhone Number

WEBSITE (IF ANY)

DOT #:

MC #:

SSN/EIN #:*

TWIC CERTIFIED:

HAZMAT CERTIFIED:

PART 2: EQUIPMENT SECTION

VAN EQUIPMENT

SIZE:

48' VAN53' VANOther

HOTSHOT/TRAILER LENGTH:

AIRRIDE:

VENTED:

TRAILER MODEL TYPE/NUMBER:

PLEASE CHECK IF YOU HAVE THE FOLLOWING:

MAX LOAD WEIGHT:

COMMENTS:

PART 4: FACTORING INFORMATION:

If you use a factoring service, please provide us with the following information. This will ensure that we only use brokers that are approved by your factoring company.

FACTORING COMPANY NAME:

CONTACT:

PHONE NUMBER:

Area CodePhone Number

WEBSITE:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

FACTORING COMPANY FORM:

Browse Files

If you do not have a factoring company are you interested in applying? (Will have the opportunity to receive pay within 1 to 2 days)

YESNO

If you do not have a factoring company or not interested in signing up, please upload a voided check to receive direct deposit. (This process can take up to 30 days to receive pay)

Browse Files

PART 5: INSURANCE 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 COMPANY*

CONTACT NAME*

First NameLast Name

Phone Number:*

Area CodePhone Number

FAX*

Area CodePhone Number

Email*

example@example.com

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

INSURANCE INFORMATION:*

Browse Files

PART 6:OTHER INFORAMTION:

PLEASE USE THE FOLLOWING SECTION TO BETTER DESCRIBE YOUR COMPANY THAT WE HAVE NOT ALREADY ASKED FOR.

COMMENTS:

CARRIER

TDA COMMUNICATION SERVICES LLC

STATES