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 Line 2

CITYSTATE

ZIP
Address Below is:

Same as aboveDifferent than above
Mailing Address*

Street Address Line 2

CITYSTATE

ZIP
MAIN CONTACT PERSON*
EMAIL*
example@example.com
CELL PHONE*
EMERGENCY CONTACT PERSON*
EMERGENCY PHONE*
MC NUMBER*
YEARS ACTIVE*
DOT NUMBER*
SCAC
PART 2: EQUIPMENT TYPES
Number and Type of Trailers*

53' VAN53' REEFER48'/53' FLATBEDPOWER ONLY
Number of Trucks:*
Number of Trailers*
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:*
Off Days
ENDORSEMENTS Y/N:*
TYPE OF ENDORSEMENTS:
CLEARANCE TYPE: (TWIC DBID RAPID GATE STA)*
ARE YOU:*

OTR (2,500 to 3,000 miles per week)REGIONAL (300 to 400 miles)LOCAL (150 miles or less)
Areas (ZONES) of the USA You Prefer to Travel:

- Please Select All That Apply -
NORTHEAST

CTDEMAMENHNJNYPARIVT
MIDWEST

IAILINKSKYMIMNMOMTNENDOHSDWI
SOUTHEAST

ALFLGAMDMSNCSCTNVAWV
SOUTHWEST

ARAZLANMOKTX
WEST

AKCACOIDNVORUTWAWY
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.
Should be Empty:

PART 1: CARRIER GENERAL INFORMATION

PART 2: EQUIPMENT TYPES

DISPATCH SPECIFICATIONS