Dispatcher - Carrier Agreement
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
MC #
*
Equipment
*
Van
Flatbed
Stepdeck or RGN
Hot Shot
Reefer
Box Truck
Other
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 Love's Solutions
*
What areas will you drive?
*
Southeast
Midwest
West Coast
North East
Pacific Northwest
Mountain
New York City (check mark if you will drive to this big city)
Chicago IL (check mark if you will drive to this big city)
Please upload your w9, insurance, authority and Notice of Assignment (of factoring of company if applicable)
*
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