Dispatcher Intake
Name
*
First Name
Last Name
Company Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Place of Residence
*
MC#
*
DOT#
*
DOT Insurance Company
*
DOT Insurance Policy #
*
Insurance Policy Expiration Date?
*
Disclaimer
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What type of trailer do you have?
*
Reefer
Dry Van
Flatbed
Auto Transport trailer
Power Only Truck
Box Truck
None of the above
What kind of driver are you?
*
(OTR) Over The Road
Local
Region
None of the above
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Truck Information
Model, Registration, Odometer, etc.
Truck make?
*
Truck model?
*
Truck year?
*
Truck VIN #?
*
Do you lease or own?
*
Lease
Own
Truck Condition?
*
New
Used - Good
Used - Fair
Needs Repairs
Truck odometer miles?
*
Truck license plate #?
*
Plate registration date?
*
Registration expiration date?
*
Truck Insurance carrier?
*
Insurance policy #?
*
Insurance expiration date?
*
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Trailer Information
Condition, Insurance, Registration, etc.
Trailer license plate #?
*
License plate registration date?
*
Registration expiration date?
*
Trailer Insurance carrier?
*
Insurance policy #?
*
Insurance expiration date?
*
Do you lease or own?
*
Lease
Own
Trailer Condition?
*
New
Used - Good
Used - Fair
Needs Repairs
Warranty date?
Warranty expiration date?
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Truck and Trailer Equipment
ELD, Straps, Load bars, Chains, etc.
Do you have an ELD?
*
Yes
No
ELD make?
If you have an ELD this field is required.
ELD model?
If you have an ELD this field is required.
What kind of equipment do you have for your trailer?
*
List all that you have.
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Permits and Licenses
CDL, Endorsements, TWIC, RAPID GATE, etc.
License expiration date?
*
What kind of CDL endorsements do you have?
*
Class A
Class B
Class C
Class D
Class H
Class N
Class P
Class S
Class T
Class X
Medic card issue date?
*
Type N/A if not required
Medic card expiration date?
*
Type N/A if not required
Inspection sticker issue date?
*
Inspection sticker expiration date?
*
Factoring Company?
If Applicable
Factoring Agent?
If Applicable
Factoring Agent Phone
If Applicable
What permits do you have?
*
TWIC
DBID
RAPID GATE
STA
Other
None
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Driver Dispatching Specifications
Zones, Home Time, CPM, etc.
What is your max preferred cost per mile (CMP)?
*
Operational cost to run your business
Are you willing to do multiple pick-ups per load?
*
Yes
No
Are you willing to assist with loading and/or unloading?
*
Yes
No
Are you willing to drive through mountains?
*
Yes
No
Do you have a Tolls membership?
*
Yes
No
What is your preferred zone?
*
Northeast (CT, DE, MA, ME, NH, NJ, NY, PA, RI, VT)
Midwest (IA, IL, IN, KS, KY, MI, MN, MO, MT, NE, ND, OH, SD, WI)
Southeast (AL, FL, GA, MD, MS, NC, SC, TN, VA, WV)
Southwest (AR, AZ, LA, NM, OK, TX)
West (AK, AZ, CA, CO, ID, NM, NV, OR, UT, WA, WY)
When would you like to be home?
*
Based on your preferred zone(s)
What are your off days?
*
When does your weekend start?
What is your max deadhead distance?
*
Max amount of miles you will drive to pick up a load with an empty trailer?
What loadboards do you currently have?
*
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Zoom Call Onboarding
Upload W9/W8-BEN, NOA/COA, Schedule Zoom, etc
MC Authority
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Certificate of Authority (COA)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
W9 or W8-BEN
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Notice of Assignment (NOA)
Browse Files
Drag and drop files here
Choose a file
If Applicable for Factoring company
Cancel
of
Onboarding Call
*
Submit
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