Hotshot/box truck

***NO CONTRACTS! CANCEL ANYTIME WITH 24HRS NOTICE***

***THE BELOW NUMBERS ARE BASED OFF OUR CURRENT DRIVERS RUNNING REGIONAL OR OTR***
- AVERAGE WEEKLY RATES ARE UP TO $7500WKLY
Complete the ptofile below and a representative from our administrative team will set up your account. Once account created, you will be assigned to an agent. Please keep in mind that a rep cannot start working on your loads until this has been completed. If you have any questions about the form, please contact us @ 318.490.0073 or admin@henosislogistics.com
Company Name*
MC/DOT #*
EIN *DO NOT ENTER SS#**
OWNERS NAME*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
MC AUTHORITY*

Cancelof
COI(CERTIFICATE OF INSURANCE)*

Cancelof
W9*

Cancelof
EQUIPMENT*

HOT SHOT 40FT+ TRAILERBOX TRUCK 26FT+
SUPPLIES*

TARPSCHAINSSTRAPSVBOARDSDUNNAGEWINCHAIR RIDE TRAILERBINDERSCOIL RACKSMEGA RAMPSOther
SELECT ALL THAT APPLY*

TWICK CARD20 YR CLEAN BACKGROUND (MILITARY LOADS)TANKERS ENDORSEMENTHAZMAT ENDORSEMENTHAZMAT CERTPPEELDOther
DRIVERS' NAME*
IF YOUR DRIVER IS AN EMPLOYEE, WOULD YOU LIKE FOR THEM TO SEE THE FULL RATE DETAILS OR ADDRESS ONLY?*

FULL RATE DETAILSADDRESS ONLY
ENTER TRUCK NO., TRAILER NO. AND DRIVER PHONE NO.*
MAX WEIGHT YOU CAN HAUL ON TRAILER? (CANNOT EXCEED 22,000LBS)*
PREFERRED HOME TIME?*
FACTORING PHONE, EMAIL, & NAME:
INSURANCE CO, PHONE, & EMAIL:*
OTHER DETAILS:
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.
Select service

Hotshot 40ft 8%Box Truck 8%
Signature*

Powered by Jotform SignClear
Should be Empty: