Semi-Truck

Please complete and submit this form. You will be assigned an agent within 72hrs.

We do work to obtain dedicated lanes for all carriers as well as direct customers. Once your account is created, you will be assigned to an agent to obtain your loads. In order to expedite the set up process. Our main line is 318.490.0073.
- NO CONTRACTS
- Lease on option
- Dispatch Services
- Invoicing Service
- Broker Set up
- Factoring Set up
If you need assistance with Tags, Fuel Cards, Aportioned Plates, and IFTA, send an email to admin@henosislogistics.com
COMPANY NAME*
MC/DOT #*
EIN# *DO NOT ENTER SSN**
OWNER NAME*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
PLEASE UPLOAD MC (AUTHORITY)*

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PLEASE UPLOAD CERTIFCATE OF INSURANCE *DO NOT UPLOAD ID CARDS**

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PLEASE UPLOAD W9*

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PLEASE UPLOAD FACTORING NOA DOCUMENT*

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EQUIPMENT*

SEMI W/ TRAILERSEMI NO TRAILER/POWER ONLY
TRAILER TYPE*

NO TRAILER53FT REEFER53FT FLATBED53FT DRY VAN48FT FLATBED
SUPPLIES*

TARPSCHAINSSTRAPSVBOARDSBLANKETSDUNNAGEETRACKSWINCH5TH WHEEL LOCKAIR RIDE TRAILERBINDERSCOIL RACKSLOAD LOCKSPAD LOCKOther
PLEASE SELECT ALL THE APPLIES TO THE DRIVER*

TWIC CARD20YR CLEAN BACKGROUND(MILITARY LOADS)TANKER ENDORSEMENTHAZMAT ENDORSEMENTHAZMAT CERTPPEELDOther
IF YOUR DRIVER IS AN EMPLOYEE, WOULD YOU LIKE FOR THEM TO SEE THE FULL RATE DETAILS OR ADDRESS ONLY?*
DRIVERS AND EQUIPMENT? TRUCK, TRAILER, NAME, & PHONE #*
MAX WEIGHT YOU CAN HAUL ON TRAILER? *PLEASE DO NOT PUT 80,000LBS**
PREFERRED HOME TIME?*
FACTORING COMPANY *PHONE, EMAIL, NAME*
INSURANCE COMPANY PHONE, EMAIL, & NAME*
ANY OTHER DETAILS?
HOW DID YOU HEAR ABOUT HENOSIS?*

GOOGLE SEARCHWALK INCALLED INREFERRALEMAILWL CALLED YOU
LOCATION FOR FIRST LOAD?*
DESIRED START DATE?

MonthDayYear
Date
Henosis Logistics will make 100% effort to keep your truck(s) loaded. We will make 100% effort to connect all carriers with reliable broker, shippers, and dedicated lanes. This service will be provided at 8% og each load.
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