OO/Carrier Intake Form
Date
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Company Name
Email
(example@example.com)
Phone Number
Please enter a valid phone number.
Equipment Type
Reefer, Dry Van, Flatbed, Power Only, Hot Shot, Box Truck
Length of Equipment/Truck
Where is your truck/business based out of?
City & State
Where are you willing to run? Where are you not willing to run?
Interstate, Intrastate Locations
Is your authority active? How long has it been active?
Don't forget to fact check!
Do you have a factoring company?
Yes
No
What are you looking to make weekly?
$ Amount
What is CPM (aka RPM) range are you looking to be at? What is your breakeven point?
Ex: $2.79 per mile
(If box truck) What is your truck’s door height?
What is your vehicle’s GVWR? What is the max weight you’re comfortable carrying?
(Gross Vehicle Weight Rating = GVWR)
Do you plan on adding more trucks to your business in the future?
Additional Information
Submit
Should be Empty: