Truckinn Cargo Intake Form
Carrier agrees they are signing as an authorized signor of the company.
Carrier Profile
This profile helps us provide the best service possible to our clients.
Company Name
*
Owner Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Office Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
After Hours Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
MC #
DOT
Type of Equipment (check all that apply)
*
Van (48' or 53')
Reefer (53')
Flatbed (48' or 53')
Power Only
Stepdeck (48' or 53')
RGN/Double Drop
Conestoga
Straight Truck 26'
Cargo Van
Hot Shot
Other
List Other Here
Number of Trucks
Year/Make/Model (per truck)
Trailer Length
Trailer Dimensions
Weight Capacity
*
Special Equipment (liftgate, straps/chains, ramps, pallet jack, etc.)
Are you on Highway? (Many brokers use this to vet carriers before engagement)
*
Yes
No
Will join asap
Do(es) your truck(s) have ELD?
*
Yes
No
Minimum Rate Per Mile
*
What areas do you travel often (check all that apply)
*
Z0 Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, Rhode Island, Vermont
Z1 Delaware, New York, Pennsylvania
Z2 Maryland, N. Carolina, S. Carolina, Virginia, W. Virginia
Z3 Alabama, Florida, Georgia, Mississippi, Tennessee
Z4 Indiana, Kentucky, Michigan, Ohio
Z5 Iowa, Minnesota, Montana, N. Dakota, S. Dakota, Wisconsin
Z6 Illinois, Kansas, Missouri, Nebraska
Z7 Arkansas, Louisiana, Oklahoma, Texas
Z8 Arizona, Colorado, Idaho, Nevada, New Mexico, Utah, Wyoming
Z9 California, Oregon, Washington, Alaska
ZC (Central) Ontario, Quebec
ZE (Eastern) New Brunswick, Newfoundland, Nova Scotia, Prince Edward Island
ZW (Western) Alberta, British Columbia, Manitoba, Saskatchewan
ZM Mexico
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Preferred Lanes/States:
Insurance Provider Name
*
Cargo Insurance Expiration Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Cargo Insurance Limit
*
Commercial Auto Insurance Limit
*
Factoring Company (if applicable)
Document Upload
We must have legible copies of Operating Authority, w9 and insurance certificate.
Upload W-9
*
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 Authority Information (FMCSA / MC Authority Letter)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Submit
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