Iron Point Distribution Carrier Intake Form
"Forged In Purpose, Sharpened Together"
Business Name (DBA)
*
Carrier Legal Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Dispatch Phone Number (if different)
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Truck & Trailer
MC Number
*
DOT Number
*
EIN Number
Date Available
*
-
Month
-
Day
Year
Date
Equipment Type
*
Please Select
Dry Van
Reefer
Flat Bed
Step Deck
Hot Shot
Power Only
Box Truck
Truck Number
Trailer Number (if applicable)
Maximum Weight Capacity
Trailer Length
Hazmat Certification
YES
NO
Load Preferences
Home City & State
Preferred Lanes
DO NOT RUN STATES
Max Dead Head Miles
Driver Start & End Times
How many loads per week?
Base Rate Per Mile:
example: $1.75
Weekend Availability?
YES
NO
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Payment Information
Quick Pay?
YES
NO
ACH
Direct Deposit
Factoring Company Name (if applicable)
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you need us to send all rate cons to factoring?
YES
NO
ADDITIONAL INFOMATION
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Please Upload ALL required Documents. ( Intake isn't complete until ALL documents have been received)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Dispatch Authorization- Do you authorize Iron Point Distribution to book loads on your behalf?
Rate Confirmation Authorization
Credit Check Authorization
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