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Company’s Name*

Address

Street Address City State / Province / Region ZIP / Postal Code

MC#

US DOT#

Contact Name

Email*

Phone#

Fax#

1. What Date Did Your Authority Became Active?

2. What Are Your Trucks Currently Grossing Per Week?

3. What Areas You Do Not Want to Run Your Truck(S)?

4. What Commodities You Do Not Want to Run?

5. Which Factoring Company Do You Use to Factor Your Loads?

6. How Many Drivers Do You Have and Which City, State They Are Based Out of?

7. How Frequently (Check All That Apply) Does Your Drivers Want to Get Home?

Daily

Weekly

Bi-Weekly

8. How Many Semi-trucks Do You Have and the Model Year of Each?

9. List the Quantity of Each Trailer Type That You Have:

Dry Van

Reefer

Flatbed

Others

10. How Much Do You Expect Our Dispatch Service to Gross Your Trucks Weekly?

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