Carrier
Name ________________________________________________________
Address
________________________________________________________
City/State/Zip
________________________________________________________
Phone
________________________________________________________
Fax
________________________________________________________
*After-hours
emergency number
(See
comments about after-hours number below.)
Dispatch Contact _______________________________________________________
MC
Number
____________________
DOT Number
Federal
ID #
____________________
Incorporated (Circle) Yes
No
Type of
Equipment: (Please circle)
RGN
Van-48 Van-53
Flat-48 Flat 53
Reefer-48 Reefer-53
Hotshots
Side Kit
Drop-Single
Drop-Double
Tarps
Does your company have the ability to do oversize
loads? (Circle)
yes no
Number of Trucks Insurance Phone #
Insurance Fax #
Special Equipment not
listed:______________________________________________________________
*After-hours
phone numbers will not be called unless there is an extreme
emergency. By providing this
number we hope to eliminate potential problems that occur at the last
minute. Thank you for
your time and interest. This
information will help us with customers that have special needs.
