OO/Carrier Intake Form
Date
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Company Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Number Of Trucks
Equipment Type
Reefer, Dry Van, Flatbed, Power Only, Hot Shot, Box Truck
Length of Equipment/Truck
What is your vehicle’s GVWR? What is the max weight you’re comfortable carrying?
(Gross Vehicle Weight Rating = GVWR)
(If box truck) What is your truck’s door height?
Where is your truck/business based out of?
City & State
Where are you willing to run? Where are you not willing to run?
Interstate, Intrastate Locations
Is your authority active? How long has it been active?
MC # and DOT# (if applicable)
Do you have a factoring company?
Yes
No
What are you looking to make weekly?
$ Amount
What is CPM (aka RPM) range are you looking to be at? What is your breakeven point?
Ex: $2.79 per mile
Do you plan on adding more trucks to your business in the future?
Additional Information
Submit
Should be Empty: