CARRIER PROFILE
Owner Full Name
*
First Name
Last Name
Company Name
*
Physical Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Mailing Address (if different from above)
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number Listed with DOT
*
-
Area Code
Phone Number
Cell Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
MC Number
*
DOT Number
*
SCAC Code
FEIN
*
Broker References
Please list three brokers that you have hauled for. If you are a new carrier, you can skip this section.
Broker Name
Contact Name
Phone Number
-
Area Code
Phone Number
Broker Name
Contact Name
Phone Number
-
Area Code
Phone Number
Broker Name
Contact Name
Phone Number
-
Area Code
Phone Number
Factoring Company Information
(If applicable)
Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Account Representative
Representative's Phone Number
-
Area Code
Phone Number
Representative's Email
example@example.com
How did you hear about us?
*
Web Search
Ameratrans Flyer/Email
Factoring Company
Insurance Company
Other
Back
Next
Equipment and Services
Tractor:
Year
*
Make
*
Truck #
*
Trailer:
Year
Make
Trailer #
Trailer Type (Select Power Only if you do not have a trailer):
*
Van
Reefer
Flatbed
Step-Deck
Power Only
Van/Reefer (Select all that apply)
Swing Door
Roll Door
Metal Roof
Fiberglass Roof
Plate Trailer (all aluminum inside/outside ex. floor)
Regular Trailer (all plywood inside)
Vented
Air Ride
Trailer Dimensions (Select all that apply)
48' Long
96" Wide
53' Long
102" Wide
Weight Capacity
Stepdeck
Bottom Well Length
Top Deck Length
Other Equipment (Select all that apply)
*
Load Bars
Straps
E-Trac
Chains
Binders
Ramps
Edge Protectors
Dunnage
Coil Racks
Tarps (provide sizes below)
None
Other
Tarp Sizes (if applicable)
Services Offered (Select all that apply)
*
TWIC
Carb Compliant
Hazmat
Tanker Endorsement
GPS Tracking
None
Other
Type of Logs
*
ELD Compliant
Paper Logs
ELD Provider
*
Area Based Out Of
*
City, State
Preferred States to Run
*
Current Location of Truck (for 1st Dispatch)
City, State
Average # of Days Out
*
Realistic Rate Per Mile Expected
*
Please verify that you are human
*
Submit
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