Carrier Intake Form

Carrier Intake Form
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
SSN or FEIN*
Name Of Company *
Or DBA
What is your USDOT number?*
What is your MC number?*
Do you have multiple trucks?
If so insert truck numbers.
What type(s) of equipment do you have? *
( Ex. semi truck no trailer)
Trailer Type(s)?*
(Ex. 53ft Reefer)
What is your trailer number?
How long are you willing to stay out on the road?*
(Ex. 3 weeks on 1 week off.)
What states do you prefer to drive?*
(Ex. Southeast region FL, GA. AL. LA ect.)
What areas of the Country should we avoid?
Choose the date in which you would like to begin dispatch services

MonthDayYear
Date
- Please upload copies of the following,
  MC Authority Letter
  Certificate Of Liability Insurance (include in photo insurance company name & phone number)
  Signed W9
  Owner's Drivers License
  Notice of Assignment (if applicable)
MC Authority Letter*

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Certificate Of Liability Insurance*

Please ensure that photo includes Insurance company name and phone number
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Signed W9*

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Owner's Drivers License*

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Notice of Assignment

This only applies to you if you use a factoring company.
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Mr. Blu’s team is excited to welcome new, hardworking talent into our growing community. Together, we’re building strong relationships, new opportunities, and a brighter future for everyone on the road. Thank you for taking the time to join us — we can’t wait to grow with you!
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