Worldwide Logistics LLC/ Carrier Packet
Legal Company Name
DBA (if any)
MC Number
*
DOT Number
*
EIN / SSN
*
Phone Number
Email Address
Back
Next
Section 2: Remittance / Payment Info
Payment Method
*
Please Select
ACH
SuperPay
Check
BANK NAME
Account Holder Name
Routing Number
Account Number
Back
Next
Section 3: Insurance Information
Insurance Company
Agent Name
Agent Phone
Policy Number
Cargo Coverage Amount
Auto Liability Amount
Back
Next
Section : Upload Documents
Upload W9
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload Certificate of Insurance (COI)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload MC Authority
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload Voided Check
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Section 5: Agreement & Signature
Carrier certifies all information is accurate and agrees to comply with Worldwide Logistics LLC terms and conditions.
Signature
Printed name
Date
Continue
Continue
Should be Empty: