Owner Operator Application

Date
IF YOU HAVE AN AUTHORITY ARE YOU WILLING TO DEACTIVATE IT.

Congratulations on your decision to lease on with us! You are literally just moments from becoming a part of our team of Owner Operators! We take great pride in making sure we provide the best working environment possible. Without teamwork, none of this would be possible. Our commitment to excellence in everything we do drives our vision, while hard work and dedication steer the wheel. It is an honor to include you in our network!

To finalize the On-Boarding process, please be sure to fill out all required information and upload all the necessary documents as well!

HAVE THE FOLLOWING PICTURES ON HAND TO SPEED UP APPLICATION CDL PHYSICAL DAMAGE INSURANCE BOBTAIL INSURANCE MVR CAB CARD
Name*
Last Name*
Date of birth*

MonthDayYear
Date
Phone Number*
Upload
Social security number *
Email*
Company Name*
Upload copy of Physical Damage Insurance on the Tractor/trailer
Take Photo
Home Address*
Street Address*
City*
Address*

Street Address Line 2

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you lived here for less than 3 years*
If you answered YES please provide your previous address
Street Address
Address

Street Address Line 2

Street Address Line 2

CityState / Province

Postal / Zip Code
City
Do you have a CDL

YESNO
How long have you held a CDL*
Do you have your own authority*
Vehicle
What equipment do you have

TractorReeferDryvanFlatbedWhat type of equipment do you have
Value of each piece of equipment
Value of each piece of equipment
Location - City, State - Region*
Any Service Restrictions location wise*
Some business prefer not to support specific regions or locations. If you have no restrictions, select the NO Restrictions option.
If you selected YES please describe restrictions in the box below if NO type "N/A
Have you had any moving violations in the past 3 years

YESNO
Preferred Lanes
What states are you willing to run*
How many days are you willing to be on the road*
Do you have a clearing house

YESNO
If you answered "YES" what company do you use?
Bank Account Number *
type your clearing house company
Bank Routing Number *
Bank Name and Address
Client agrees to indemnify, defend and hold harmless Mack N Mash Inc and it's officers, employees, affiliates and agents from and against any and all losses, liabilities, claims or damages asserted by third parties arising out of or in connection with Mack N Mash Inc
performance of it's obligations under the Agreement, except to the the extent that such losses, liabilities, claims or damages are judicially determined to have resulted directly and primarily from the willful misconduct or gross negligence of Mack N Mash Inc. Client agrees to strict no refund policy. Client further agrees to indemnify, defend and hold harmless Mack N Mash Inc. and its officers, employees affiliates and agents from and against any and all losses, liabilities, claims or damage asserted by third parties arising out of or in connection with any and all misrepresentations or false or misleading information made to any party, including Consulting, by Client or any of its officers, employees, affiliates or agents

AGREE
If you have an ELD?*
Is the previously mentioned ELD issued by Motive? If not, what type of ELD do you have*
Are you the driver?

YESNO
How did you hear about us*
Signature

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