CARRIER PROFILE FORM

CARRIER PROFILE FORM

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.
To assist us in setting up your accounts with brokers, please upload copies of your:

Operating Authority, Certificate of Insurance, and a completed W-9 form.
Operating Authority Form*

Certificate of Authority (MC/DOT).
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Certificate of Insurance*

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Completed W-9 Form

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1. Download the W-9 Form here: https://www.irs.gov/pub/irs-pdf/fw9.pdf

2. Go to https://smallpdf.com/sign-pdf, upload the form there.

3. Fill and sign the W-9 Form then download it and upload it here.
NOTE: To save time, you can also directly fill out and submit the W9 Form to us here: Form W-9: Request for Taxpayer Identification
Company Information
Company Legal Name:*
Doing Business As (DBA):
If any.
Company Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Main Contact:*

First NameLast Name
Phone Number:*
Email:*
Any Drivers TWIC Certified:*

YesNo
HAZMAT Certified (Company Level):*

YesNo
Employer Identification Number (EIN):*
MC Number:*
DOT Number:*
Driver Information

If you are the only driver, please skip this section.
Driver 1 Name, Phone Number, and Home City & State:
Driver 2 Name, Phone Number, and Home City & State:
Driver 3 Name, Phone Number, and Home City & State:
Additional Drivers:
Equipment Information
# of POWER-ONLY:*
# of REEFERS (48-53ft):*
# of DRY VANS (48-53ft):*
# of FLATBEDS (48-53ft):*
NOTE: FLATBEDS MUST HAVE FULL SECUREMENT EQUIPMENT.

View full list here: Flatbed Securement List
Truck #:
Trailer #:
ELD Provider:
Broker Information

Please list ALL brokers you are already set up with. If you are a new carrier, you can skip this section.
Broker Names:
Insurance Information

Please provide us with ALL the following information to ensure we can call (or login to) your insurance company and add brokers to your insurance as additional insureds in a timely manner.
Insurance Company Name:*
Name of Contact:*
Contact Phone Number:*
Web Portal URL:
Web Portal Login Username (makes booking loads easier and smoother):
Web Portal Login Password (makes booking loads easier and smoother):
Factoring Information

If you use a factoring service, please provide us with the following information.
Name of Factoring Company:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person:
Contact Number
Web Portal URL:
Web Portal Login Username (makes booking loads easier and smoother):
We will need the login information to run credit checks on brokers and/or upload BOLs, if requested.
Web Portal Login Password (makes booking loads easier and smoother):
Please upload your Factoring Company's Notice of Assignment (NOA) and/or Credit Application, if applicable:

We will send this to the broker to fill out when setting you up with them.
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Dispatch Specifications

Please enter your dispatch specifications below. We promise to do our very best to find loads according to your requirements. We understand there are many factors at play, but this will give us a starting point.
Home Base (City & State):
Preferred Max Load Weight (lbs):
Minimum Cents Per Mile ($):
Max # of Pickups:
Max # of Deliveries:
Driver Touch (Y/N):
Tolls (Y/N):
Mountains (Y/N):
Endorsements (Y/N):
If Yes, enter endorsements below.
Type of Endorsements:
Clearance Type (if any):
Preferred Areas (Zones)

Select ALL preferred states.
Northeast Region (Select states):

ALLCTDEMAMENHNJNYPARIVT
Midwest Region (Select states):

ALLIAILINKSKYMIMNMOMTNENDOHSDWI
Southeast Region (Select states):

ALLALFLGAMDMSNCSCTNVAWV
Southwest Region (Select states):

ALLARLANMOKTX
Western Region (Select states):

ALLAKAZCACOIDNVORUTWAWY
Additional Comments (states to avoid, home time, etc.):
Please verify that you are human:*
Should be Empty:

CARRIER PROFILE FORM

Company Information

Driver Information

Equipment Information

Broker Information

Insurance Information

Factoring Information

Dispatch Specifications

Preferred Areas (Zones)