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Please complete the following form and be as thorough as possible.

General Information

Company Name: FHWA #:
Main Dispatcher: Fed ID #:
Mailing Address:
City, ST Zip:
Phone: Fax:
Toll-free phone: 24-hour phone:
Name of whom to pay (if different from above):
Mailing Address:
City, ST Zip:
Phone: Fax:
Does your company have other affiliations? Yes  No If so, whom?

Equipment (Check all that apply & number of each)

Trailer Type Number Trailer Type Number Trailer Type Number
48’ Vans 48’ Reefers 48’ Flatbeds
53’ Vans 53’ Reefers 53’ Flatbeds
Other: Number:
Do you handle HAZMAT? Yes  No Do you exchange pallets?  Yes  No

Drivers

How do you communicate with drivers? (Check all that apply)
SATELLITE CELL PHONE PAGER CHECK-CALL
Do you have teams available? Yes  No # Teams:
May we advance your drivers? Yes  No

Lanes

List six states/provinces to which your company delivers most frequently.
List two states/provinces to which your company prefers to return most frequently.

Insurance

Insurance Company Name:
Agent’s Name: Agent’s Phone:

Trade References (Please list two)

Name: Phone:
Name: Phone:

 

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