Dispatcher - Carrier Agreement
Let us know how we can help you!
Company Name
*
Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Equipment
*
Flatbed
Reefer
Stepdeck
Cargo/Sprinter Van
Van
Box Truck
Hotshot
Other
Truck Information
*
Truck Dimensions
*
Add More Trucks (optional)
Dimensions
Please list your truck equipment (Tarps, Straps, Chains, Ramps, Air Ride, etc)
*
Please use the section below to better describe your company. Include special terms and conditions of most importance and everything we must consider while searching and taking the loads for you.
*
Please provide us your ideal (reasonable) rate information for a starting point.
*
Insurance Information: Your agents PH #, Email
*
Factoring Company Info: Your contacts info, Email and PH #
*
What zones will you drive?
ZO - Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, Rhode Island, Vermont
Z1- Delaware, New York, Pennsylvania
Z2- Maryland, N. Carolina, S. Carolina, Virginia, W. Virginia
Z3- Alabama, Florida, Georgia, Mississippi; Tennessee
Z4 - Indiana, Kentucky, Michigan, Ohio
Z5 - lowa, Minnesota, Montana, N. Dakota, S. Dakota, Wisconsin
Z6 - Illinois, Kansas, Missouri, Nebraska
Z7 - Arkansas, Louisiana, Oklahoma, Texas
Z8- Arizona, Colorado, Idaho, Nevada, New Mexico, Utah, Wyoming
Z9 - California, Oregon, Washington, Alaska
Open To Any Zone
Will you be willing to recommend us?
Maybe
Yes
No
REQUIRED DOCUMENTS: W9, COI (Insurance), MC Authority, and Notice of Assignment (of factoring of company if applicable)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload pictures of your vehicle (Front, Back, Left & Right Side, Cargo Area) Some brokers will REQUIRE this and we want to show you off!
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Preferred Payment Method
*
PayPal
Zelle
Cash App
Apple Pay
Bank Transfer
Submit
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