BECOME A CARRIER Become a Carrier Carrier Setup FormLastNameEmailCompany NameDBA (if any)Street AddressAddress Line 2CityStateZip CodeUnited State of AmericaPrimary Phone Number *Secondary Phone NumberEmergency Contact NameEmergency Contact NumbersWebsite URL (if any)DOT NumberMotor Carrier NumberSSN/EINTWIC CardHAZMAT CERTIFICATION (If yes please provide Hazmat Certification PDF and Training Certs)Choose FileNo file chosenDelete uploaded fileEquipment (All Flatbeds must have their own securement equipment to include tarps!!!) *Van/ReeferFlatbedStep DeckHot ShotBox TruckOtherChoose all that applyPPE GearDollyAir RideStraps/BindersStraps/BindersLift GateDock HighPallet JackAny other details, please specify.Truck NumberTrailer numberTrailer LengthTrailer Dimensions (Box Truck, VANs & Reefers ONLY L X W X H)Lanes you like to Travel (will be discussed over the phone as well)Cost per Mile ( Total Monthly Expenses/Miles per month + Average cost of 1 gallon of Fuel/Miles per Gallon your Truck averages = Cost per Mile) *Worksheet can be ProvidedFactoring Company (to ensure we deal only with brokers that are approved by your company)Factoring Company Agent Name (full name)Factoring Company Email *Website (For Factoring)Factoring Company UsernameInsurance CompanyInsurance Agent NameInsurance Agent Phone NumberInsurance Agent Email (for Certificate Requests)MC Authority LetterChoose FileNo file chosenDelete uploaded fileW9 FormChoose FileNo file chosenDelete uploaded fileNOAChoose FileNo file chosenDelete uploaded fileCertificate of InsuranceChoose FileNo file chosenDelete uploaded fileVoid ChequeChoose FileNo file chosenDelete uploaded fileSubmit