Carrier Profile Form

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XLENT may request additional documentation to support the data you provide. Likewise, all correspondence will be generated from the company information submitted below, please ensure information is accurate and inclusive of your operation. We truly appreciate your time completing this process.
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Carrier Name:* This field is required.Legal Name as listed with Federal Motor Carrier
3
Carrier Main Phone No. :* This field is required.
4
Company Start Date:The date you started operation
Month
Day
Year
5
Main Contact* This field is required.This should be the person legally authorized to represent the company
First Name
Last Name
6
Main Contact E-mail :* This field is required.
Where the confirmation will be sent to
7
Main Contact Phone Number* This field is required.
8
MC Number :Docket number as listed with FMCSA
(e.g. 123456789)
9
DOT Number :* This field is required.As registered with FMCSA
(e.g. 123456789)
10
Federal Tax ID :* This field is required.
(e.g. 123456789)
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Company Address :* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
12
Billing Contact* This field is required.
First Name
Last Name
13
Billing Contact Phone Number(###) ###-####
14
Send Payments to :
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
15
Please Select your Factoring Company* This field is required.If your company does not factor please select "DO NOT FACTOR"
Do Not Factor
Accutrac Capital Solutions
Advanced Business Capital, LLC dba Triumph Business Capital
Aerofund Financial, Inc.
America Factors
Amerisource Business Capital
Apex Capital Corp
Atlas
BAM CAPITAL LLC
Bibby Transportation Finance
Big Brother Financial
BYCO
Century Finance LLC
Corefound Capital
Dorado Finance
Dove Financial
Eagle Capital Corp
ECapital LLC
Engaged Financial
Far West Capital
Financial Carrier Services
Flash Funding LLC
Foley Business Capital
Freight Factoring Specialist
G SQUARED FUNDING LLC
Gulf Coast Bank
Integra Funding Solutions
Interstate Capital
Ithrive Funding LLC
Loves Solutions, LLC
Match Factors
MDR Capital LLC
MHC Financial Services
Open Road Financial Services
Orange Commercial Credit
OTR Capital LLC
Outsource Financial Services Inc
Parikh Financial LLC
Pay4Freight.com
Phoenix Capital Group, LLC
Porter Billing Services, LLC
Power Funding LTD
Provident Commercial Finance, LLC
R & K Services, LLC
RIVERSIDE
Riviera Finance of Texas
RTS Financial Service, Inc
Sierra Finance
Single Point Capital
SS Brown Funding
Steelhead Finance
Summar Financial LLC
Sunbelt Finance
TAFS, INC.
TBS Factoring Service,LLC
Thunder Funding
Transam Financial Services
Transport Factoring Inc
Treadstone Capital US
Triumph Business Capital
Truckstop Factoring
TTI
United Federal Funding
Wex Fleet One Factoing
WGC Transport Services, LLC
OTHER
If your factoring company is not listed please select "Other" and attach your NOA with your documents below
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Dispatch Phone Number
17
Emergency Contact
First Name
Last Name
18
Emergency Contact Phone Number
19

Operation Information :

Information below will expedite the process to coordinate the proper load possibilities and desired lane of service. Please provide as much information as possible in order to have a detailed profile about your company.
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Carrier Type:* This field is required.
Carrier Only
Carrier/Broker
21
Total Number of Trucks
22
Trailer Size & Quantity (Please insert quantity for type and size)
28'
40'
45'
48'
53'
other
Flatbed
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
StepDeck
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Van
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Reefer
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
RGN
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Hot Shot
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Flatbed
StepDeck
Van
Reefer
RGN
Hot Shot
28'
Row 0, Column 0
40'
Row 0, Column 1
45'
Row 0, Column 2
48'
Row 0, Column 3
53'
Row 0, Column 4
other
Row 0, Column 5
28'
Row 1, Column 0
40'
Row 1, Column 1
45'
Row 1, Column 2
48'
Row 1, Column 3
53'
Row 1, Column 4
other
Row 1, Column 5
28'
Row 2, Column 0
40'
Row 2, Column 1
45'
Row 2, Column 2
48'
Row 2, Column 3
53'
Row 2, Column 4
other
Row 2, Column 5
28'
Row 3, Column 0
40'
Row 3, Column 1
45'
Row 3, Column 2
48'
Row 3, Column 3
53'
Row 3, Column 4
other
Row 3, Column 5
28'
Row 4, Column 0
40'
Row 4, Column 1
45'
Row 4, Column 2
48'
Row 4, Column 3
53'
Row 4, Column 4
other
Row 4, Column 5
28'
Row 5, Column 0
40'
Row 5, Column 1
45'
Row 5, Column 2
48'
Row 5, Column 3
53'
Row 5, Column 4
other
Row 5, Column 5
1 of 6
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Apportioned Lanes : * This field is required.
INTER-STATE (UNITED STATES)
INTRA-STATE ONLY
MEXICO
CANADA
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Submit Required Documents - (1) W-9 (2) Cert of Ins (3) Operating Authority (4) NOA -Factoring Company (5) Completed Broker Carrier Master Agreement
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Do not close your browser until all documents have been uploaded
Cancelof
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By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this profile. When you press the submit button, you will receive an email confirmation that your profile was received. Please print for your records and retain as verification of your submittal.
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E-Signature:
Should be Empty: