AMIES LOGISTICS LLC - Dispatch Intake Questionnaire Form
This intake form allows us to gather important details about your business and logistics requirements to ensure smooth and efficient service.
Name
*
First Name
Last Name
Business Name (if applicable):
*
Put N/A if none
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Section 1: Experience Level
Are you new to trucking/dispatching?
*
Yes
Some Knowledge
Experienced
Have you ever dispatched before?
*
Yes
No
If yes, how long?
*
Section 2: Business Setup
Active business registered?
*
Yes
No
MC Number?
*
Yes
No
In Progress
DOT Number?
*
Yes
No
In Progress
Insurance set up??
*
Yes
No
Section 3: Equipment Information
Truck Type:
*
Please Select
Box
Truck
Semi
Reefer
Flatbed
Hotshot
Others
If others, please specify:
Truck Dimensions:
*
Weight Capacity:
*
Section 4: Dispatch Goals
Goals:
*
Please Select
Start Business
Dispatch Others
Own Trucks
Extra Income
Other
If others, please specify:
Trucks planned
*
1-2
3-5
6+
Weekly Income Goal:
*
Section 5: Availability
Hours/day:
*
1-2
3-5
6+
OTR Available?
*
Yes
No
Days Available:
*
Please Select
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Section 6: Knowledge
Load boards experience?
*
Yes
No
Rate negotiation experience?
*
Yes
No
Familiar with:
*
Please Select
Rate Confirmations
Carrier Packets
BOL
Invoicing
None
Section 7: Training
Interested in mentorship?
*
Yes
No
What do you want to learn?
*
Agreement
*
I certify that the information provided is accurate.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: