Carrier Registration
CARRIER INFORMATION
* Fields are Mandatory
Agreement Date:
12/04/2024
DOT#
*
DOT already Exists
MC#
CA#
Are you a broker or carrier?
*
Select
Broker
Carrier
Authorized Person
*
Title
*
Legal Company Name
DBA
Email
*
Email already Exists
Physical Address
*
State
*
Select State
AL - ALABAMA
AR - ARKANSAS
AZ - ARIZONA
CA - CALIFORNIA
CO - COLORDADO
CT - CONNECTICUT
DE - DELAWARE
FL - FLORIDA
GA - GEORGIA
IA - IOWA
ID - IDAHO
IL - ILLINOIS
IN - INDIANA
KS - KANSAS
KY - KENTUCKY
LA - LOUISIANA
ME - MAINE
MD - MARYLAND
MA - MASSACHUSETTS
MI - MICHIGAN
MN - MINNESOTA
MS - MISSISSIPI
MO - MISSOURI
MT - MONTANA
NE - NEBRASKA
NV - NEVADA
NH - NEW HAMPSHIRE
NJ - NEW JERSEY
NM - NEW MEXICO
NY - NEW YORK
NC - NORTH CAROLINA
ND - NORTH DAKOTA
OH - OHIO
OK - OKLAHOMA
OR - OREGON
PA - PENNSYLVANIA
RI - RHODE ISLAND
SC - SOUTH CAROLINA
SD - SOUTH DAKOTA
TN - TENNESSEE
TX - TEXAS
UT - UTAH
VT - VERMONT
VA - VIRGINIA
WA - WASHINGTON
WV - WEST VIRGINIA
WI - WISCONSIN
WY - WYOMING
City
*
Zip Code
*
Phone
*
Fax
How long have you been in business?
Select
0-5 years
6-10 years
11-15 years
15+ years
Miles per year?
Select
25K – 75K
76K – 100K
101K – 125K
125K+
Cargo Specialties
(Select all that apply)
General Freight
Household Goods
Metal, Sheets, Coils, Rolls
Motor Vehicles
Building Materials
Machinery, Large Objects
Fresh Produce
Intermodal Containers
Oilfield Equipment
Livestock Containers
Grain, Feed, Hay
Coal/Coke
Meat
US Mail
Chemicals
Commodities Dry Bulk
Refrigerated Food
Beverages
Paper Products
Utility
Farm Supplies
Construction
Hazardous Material
Box Truck/ Van/ Final Mile
Payment Methods
(Select all that apply)
ACH
ComCheck
PayPal
What is your racial or ethnic identification?
Select
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other
I prefer not to say
Are you a minority owned business?
Select
No
Yes
Are you a female-owned business?
Select
No
Yes
Are you a veteran-owned business?
Select
No
Yes
ADD FACTORING INFO, IF APPLICABLE
Factoring Company Name
Contact Name
Phone
Fax
Physical Address
State
Select State
AL - ALABAMA
AR - ARKANSAS
AZ - ARIZONA
CA - CALIFORNIA
CO - COLORDADO
CT - CONNECTICUT
DE - DELAWARE
FL - FLORIDA
GA - GEORGIA
IA - IOWA
ID - IDAHO
IL - ILLINOIS
IN - INDIANA
KS - KANSAS
KY - KENTUCKY
LA - LOUISIANA
ME - MAINE
MD - MARYLAND
MA - MASSACHUSETTS
MI - MICHIGAN
MN - MINNESOTA
MS - MISSISSIPI
MO - MISSOURI
MT - MONTANA
NE - NEBRASKA
NV - NEVADA
NH - NEW HAMPSHIRE
NJ - NEW JERSEY
NM - NEW MEXICO
NY - NEW YORK
NC - NORTH CAROLINA
ND - NORTH DAKOTA
OH - OHIO
OK - OKLAHOMA
OR - OREGON
PA - PENNSYLVANIA
RI - RHODE ISLAND
SC - SOUTH CAROLINA
SD - SOUTH DAKOTA
TN - TENNESSEE
TX - TEXAS
UT - UTAH
VT - VERMONT
VA - VIRGINIA
WA - WASHINGTON
WV - WEST VIRGINIA
WI - WISCONSIN
WY - WYOMING
City
Zip Code
ADDITIONAL INFORMATION
Disptach Person Name
*
Dispatch Phone
*
After-Hours Dispatch Person Name
*
After-Hours Dispatch Phone
*
SCAC Code
Federal Tax ID
*
Please enter Federal Tax ID
Please enter valid Federal Tax ID
TWIC Certified?
Select
No
Yes
Hazmat Certified?
*
Select
No
Yes
Hazmat Expiration Date
Authorized Signature
*
Preferred Lanes
Service Area
*
Select
Local
Regional
National
Operating States
(Select all that apply)
AL - ALABAMA
AR - ARKANSAS
AZ - ARIZONA
CA - CALIFORNIA
CO - COLORDADO
CT - CONNECTICUT
DE - DELAWARE
FL - FLORIDA
GA - GEORGIA
IA - IOWA
ID - IDAHO
IL - ILLINOIS
IN - INDIANA
KS - KANSAS
KY - KENTUCKY
LA - LOUISIANA
ME - MAINE
MD - MARYLAND
MA - MASSACHUSETTS
MI - MICHIGAN
MN - MINNESOTA
MS - MISSISSIPI
MO - MISSOURI
MT - MONTANA
NE - NEBRASKA
NV - NEVADA
NH - NEW HAMPSHIRE
NJ - NEW JERSEY
NM - NEW MEXICO
NY - NEW YORK
NC - NORTH CAROLINA
ND - NORTH DAKOTA
OH - OHIO
OK - OKLAHOMA
OR - OREGON
PA - PENNSYLVANIA
RI - RHODE ISLAND
SC - SOUTH CAROLINA
SD - SOUTH DAKOTA
TN - TENNESSEE
TX - TEXAS
UT - UTAH
VT - VERMONT
VA - VIRGINIA
WA - WASHINGTON
WV - WEST VIRGINIA
WI - WISCONSIN
WY - WYOMING
Vehicle Type
Select
Sleeper
Day Cab
Straight truck - ’16
Straight truck - ’16 w/ Lift gate
Straight truck - ’26
Straight truck - ’26 w/ Lift gate
Reefer straight truck - ’16
Reefer straight truck - ’16 w/ Lift gate
Reefer straight truck - ’26
Reefer straight truck - ’26 w/ Lift gate
Sprinter van
Fleet Size
Trailer Type
Select
Double drop deck
Drop deck
Dry van – 28’
Dry van – 48’
Dry van – 53’
Flatbed 48’
Reefer – 28’
Reefer – 53’
Tanker
Trailer Count
Attach Documents
Document Type
Select
DOT certificate
Insurance
W9
Other
file format pdf only
Upload Document
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