DQ FILE SETUP-DRIVER SUMMARY INTAKE

Legal Company Name

U S D O T NUMBER

HM Company ID

Primary Contact

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

All drivers included in your selected package must be listed. Incomplete submissions will delay processing.

DRIVER INFORMATION

Submit this form once per company. List all drivers included in the selected and paid DQ File Setup package.

Driver Count-This selection must match the DQ File Setup option selected and paid for.*

Internal Driver Count Check

Acknowledgment- I acknowledge that the number of drivers listed above must match the number of drivers listed under my USDOT#.*

YES

Driver (1) Full Name

Driver (2) Full Name

Driver (3) Full Name

Driver (4) Full Name

Driver (5) Full Name

Driver (6) Full Name

Driver (7) Full Name

Driver (8) Full Name

Driver (9) Full Name

Driver (10) Full Name

Driver (11) Full Name*

Driver (12) Full Name*

Driver (13) Full Name*

Driver (14) Full Name*

Driver (15) Full Name*

Driver (16) Full Name*

Driver (17) Full Name*

Driver (18) Full Name*

Driver (19) Full Name*

Driver (20)Full Name*

Driver (21) Full Name*

Driver (22) Full Name*

Driver (23) Full Name*

Driver (24) Full Name*

Driver (25) Full Name*

Driver (26)Full Name*

Driver (27)Full Name*

Driver (28)Full Name*

Driver (29)Full Name*

Driver (30)Full Name*

Driver (31) Full Name*

Driver (32) Full Name*

Driver Type*

Vehicle Type?

Do you cross state lines or haul loads that originated or end in another state ?

What is the GVWR (gross vehicle weight rating) of the truck you operate?

Do you pull a trailer ?

What is the combined GVWR (GCWR) when hooked?

I understand that this form must be submitted once per company. Only drivers covered by the company completing this form can be assessed.Additional drivers require a separate submission.*

I confirm that I have listed all drivers covered under my DOT number, and I understand that Free Motor Carrier Services may contact me to discuss findings and schedule a follow-up appointment if needed.

YESNO

Preferred Day ( If we need to call )

WednesdayThursday

Preferred Time ( If we need to call )

Mornings (10am-12pm)Afternoons (1pm-4pm)Evenings (5pm-7pm)

DQ FILE SETUP-DRIVER SUMMARY INTAKE

Company Information