Carrier Profile
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
Company Name
*
MC #
*
Equipment
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Van
Flatbed
Stepdeck or RGN
Reefer
Max Weight Limit
*
Please list your securements (Tarps, Straps, Chains, lift gate, ramps, etc)
*
Insurance Information: Your agents PH #, Email (so we are able to attain your COI for your clients/brokers)
*
Factoring Company Info: Your contacts info, Email and PH # (Please also state how we will vet credit on your clients/brokers) If you do not have a factoring, put N/A and we will refer you to our relationship with WEX Capital.
*
What areas will you drive?
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Southeast
Midwest
West Coast
North East
Pacific Northwest
Mountain
New York City?
Chicago IL?
Please upload your w9, insurance, authority and Notice of Assignment (of factoring of company if applicable)
*
Browse Files
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Referral Name (Optional)
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*
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