WDW LOGISTICS – Carrier Intake Form
Let’s get you loaded. Fill this out so we can start finding you loads ASAP.
Serious carriers only. Incomplete forms will not be processed.
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
How did you hear about us?
*
Please Select
Facebook
Instagram
LinkedIN
YouTube
Text or Email
Other (Please specify...)
Other
*
MC #
*
Equipment
*
Van
Reefer
Box Truck
Max Weight Limit
*
Please list your securements (Tarps, Straps, Chains, lift gate, ramps, etc)
*
Insurance Information: Your agents PH #, Email (so we are able to attain your COI for your clients/brokers)
*
Factoring Company Info: If you have a factoring company, enter the name, contact person, email, and phone number below.If you do not have one, type N/A and we can connect you with one if needed.We verify brokers to help protect your payments.
*
Tell us about your yourself, your goals: IE Where do you see your company in the next 2 years, 5 years, etc
*
How often do you want to be home?
*
Where do you prefer to run? (Select all that apply)
*
Southeast
Midwest
West Coast
North East
Northwest
Mountain
Are you willing to run major cities?
*
Yes
No
Please give reference of any two people whom you feel would like our services:
Rows
Full Name
Address
Contact Number
1
2
Please upload your w9, insurance, authority and Notice of Assignment (of factoring of company if applicable)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Driver's Name, Driver Cell # if you will not be driving
*
Agreed terms
Please enter the agreed Dispatching Fee: (Samantha Socci and you agreed to this fee amount, if you have not spoken to Samantha - her default fee is 15%)
Dispatch Agreement By submitting this form, you agree that WDW Logistics will assist in finding and managing loads based on your preferences and availability.
Signature
Submit
Submit
Should be Empty: