1- Carrier Information
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Email
example@example.com
MC#
DOT#
SCAC#
TWIC#
Hazmat#
Additional Info
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2- Equipment Information
No. of Truck(s)
No. of Trailer(s)
No. of Van(s)
No. of Reefer(s)
No. of Flatbed(s)
Additional Info.
3- Areas of Operation
Type a question
AL
AZ
AR
CA
CO
CT
DC
DE
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Additional Info.
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4- Factoring Information
If you use factoring service, please provide the following information. This will ensure that we only use brokers approved by your factoring company.
Factoring Company Name
Website
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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6- Insuance Information
Please provide us with your insurance contact information, where we can request certificate of insurance with specific holders. (i.e. brokers and/or shippers).
Insurance Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Your Agent Name
Agent Phone No.
Please enter a valid phone number.
Agent Email Address
example@example.com
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7- Documents
Copy of MC Permit
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A Signed W9 Form
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Copy of Operator's and all Drivers' Drivers Lincense(s)
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Certificate of Insurance
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The COI must list following as Certificate Holder: Ameristar Logistics PO Box 250123, Plano TX 75025
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