CARRIER PROFILE

CARRIER PROFILE
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 should 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 1: CARRIER GENERAL INFORMATION
COMPANY NAME:
DBA (If Any):
PHYSICAL ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MAILING ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MAIN CONTACT PERSON:
E-MAIL:
example@example.com
OFFICE PHONE:
Please enter a valid phone number.
FAX:
CELL PHONE:
Please enter a valid phone number.
EMERGENCY CONTACT PERSON:
EMERGENCY PHONE:
Please enter a valid phone number.
MC NUMBER:
YEARS ACTIVE:
DOT NUMBER:
SCAC:
PART 2: EQUIPMENT TYPES

Number and Type of Trailers:
53’ VAN:
53’ REEFERS:
48’/53’ FLATBED:
POWER ONLY:
Truck #’s:
Trailer #’s:
Trailer Accessories for your specific equipment types (Dry Van, Reefer, and Flatbed):
OTHER TYPES:
PLEASE LIST THE BROKERS THAT YOU ARE ALREADY SET UP OR APPROVED WITH BELOW:
DISPATCH SPECIFICATIONS
Please give us your minimum cents per mile information. We understand that many factors will change this information, but this will give us a starting point.
CENTS ($) PER MILE:
MAX # OF PICK UPS:
MAX # OF DELIVERIES:
DRIVER TOUCH (Y/N):
Mountains? (Y/N)
TOLLS? (Y/N)
Weight Limit
HOME TIME:
ENDORSEMENTS (Y/N):
TYPE OF ENDORSEMENTS:
CLEARANCE TYPE: (TWIC, DBID, RAPID GATE, STA)
Areas (ZONES) of the USA you like to travel – Please check all that apply
Northeast

CTDEMAMENHNJNYPARIVT
Midwest

IAILINKSKYMIMNMOMTNENDOHSDWI
Southeast

ALFLGAMDMSNCSCTNVAWV
Southwest

ARAZLANMOKTX
West

AKAZCACOIDNMNVORUTWAWY
COMMENTS:
NOTE: When returning the Dispatcher Packet, which includes the completed Dispatcher Agreement, the Carrier Profile and the Limited Power of Attorney, please include COPIES of your MC Authority Letter (Certificate), Certificate of Insurance (C.O.I.), and W9. If you are working with a factoring company, please also include a copy of factoring company’s credit application so that they can run the credit on the brokers and send a Notice of Assignment (N.O.A.) if the credit is favorable. Thank you.
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CARRIER PROFILE

DISPATCH SPECIFICATIONS