CARRIER PROFILE FORM

MC

DOT

Carrier name

Physical address

Mailing address

Contact Name

Phone #

Fax

Dispatcher

Email Address

example@example.com

Remit to or Factoring Company

Federal Tax ID

Company Type: [ ] Corp [ ] LLC [ ] Partnership [ ] Sole Proprietorship

Do you allow advances via TChek to your drivers for operating expenses (fuel/lumpers)? Yes or No

Do you allow payments in full via TChek to your drivers? Yes or No

Please give the CURRENT COUNT for the following equipment types: 48' Reefers: 53' Flatbeds:Double Drops: 48' Vans: van Step decks:Bulk wet:Tractors: 53' Vans:53' Reefers: Curtain Sides:Landoll: 48' Flatbeds: 57' Vans:Bulk dry: Does your fleet contain vented vans? Are you Haz-Mat qualified? lbs. Max net cargo weight:

Max net cargo weight

EQUIPMENT PROFILE