Carrier Set Up Form - M&J Dispatch Consulting & Training

New Carrier Form

CARRIER SET-UP FORM (QUICK, EASY AND SECURE)

"*" indicates required fields

Company Name/DBA:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Person:*

First Last

Office Phone Number:*

Cell Phone Number:*

Fax Number:

Email*

MC #*

DOT #*

FIN #*

CHR # (if applicable)

Name of Insurance Company*

Contact Person for Insurance*

First Last

Insurance Company Phone Number*

Name of Factoring Company

Contact Person for Factoring Company

First Last

Factoring Company Phone Number

How many Trucks do you have?*

What type of Equipment do you have?*

Driver Information*

Single Driver

Team Drivers

Both

Emergency Contact*

First Last

Phone Number and Relationship of Emergency Contact*

Please let us know any information you would like for us to know. Please include what states you do not want to drive in and when you prefer to be at home.*

Please e-mail additional required forms to matt@mjdispatch.com*

Certificate of Insurance (COI)

Signed W-9

Copy of Authority MC#

Notice of Assignment (NOA) if factoring

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