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Please complete the following information in order to be considered for a position as an agent for GTO 2000.  Be as thorough as possible so as not to delay processing.  This information will only be used by GTO 2000, Inc. for purposes of evaluating your qualifications, and will not be used in any other way or given to any other person or company.

First Name: Last Name:
Driver License Number & ST: Social Security Number:
Home Address:
City, State  Zip Code:
Mailing Address (If Different):
City, State Zip Code:
Home Phone: Fax Number:
E-mail Address:
Present Company: Business Phone:

 

How would you like correspondence sent? How did you hear about this company?
By home address provided Trade Paper advertisement
By mailing address provided Newspaper advertisement
By fax number provided Internet advertisement or other link
By E-mail Internet search engine
Friend
Other:

Qualifications

Are you currently working as a transportation broker? yes    no
If so, for how long?
How many established customers do you have? (enter 0 for none)
Do you have a reliable carrier following? yes   no

Are there any other qualifications you would like us to know?

Authorization

"I certify that the facts contained in this form are true and complete to the best of my knowledge and understand that, if contracted, falsified statements on this form shall be grounds for nullification of contract.

I authorize GTO 2000, Inc. to obtain any personal credit reports regarding my personal credit history, provided that GTO 2000, Inc. abides by and adheres to the requirements of the Fair Credit Reporting Act.  I also authorize GTO 2000, Inc. to perform a background check with Federal, State and/or Local Authorities if necessary.

I authorize the references listed above to give you any and all information concerning my previous relationship with them and any pertinent information they may have, personal or otherwise. I also release GTO 2000, Inc. from all liability for any damage that may result from utilization of such information.

By submitting this information, I agree to the above statement."