Dispatch Carrier Application
Applicant Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Company Name
*
MC Activation Date
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
US DOT
*
MC #
*
EIN
*
Number Of Trucks
*
Please Select
1
2
3
4
5
6
7
8
9
10
11 or more
Equipment Description
*
please include year, make, model, GVWR
Current average Rate Per Mile
*
please provide current average rate per mile
Area Of Operation
*
Please Select
Regional To Address
Lower 48 States
Driver Availability
*
Please Select
Part-Time
Over-The-Road (full time)
No Fly Zones
*
please list any states you prefer to not travel
Insurance Information
*
please include issuing company name, phone, and policy number
Do you have a factoring company ?
*
Yes
No
Factoring Company Name
if not currently factoring, we can assist
Factoring Company Email
if not currently factoring, we can assist
Factoring Company Phone
if not currently factoring, we can assist
If you have factoring company please provide the login details below (email & password)
UPLOAD YOUR NOTICE OF ASSIGNMENT
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
UPLOAD YOUR W-9
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
UPLOAD YOUR Certificate of Insurance
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
UPLOAD YOUR Letter of AuthorIty
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Driver Information
please complete this section if different from applicant
Driver Name
First Name
Last Name
Driver Phone
Please enter a valid phone number.
Agree To Pursue
By checking this box you agree to allow The Compass Circle and it's partners to pursue and secure freight contracts on your behalf, using the provided information.
I Agree
Submit
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