Carrier Profile Sheet

Legal Name: ____________________________________________________________

DBA or Company Name: ___________________________________________________

Address: ________________________ City: ____________ State: _______ZIP:_______

Telephone Number Office: ______________ Home:_______________ Cell: ____________

Fax Number: ______________ eMail Address: ___________________________________

Equipment Tractor-Year: _______ Make:  ____ Model:  ____ Tractor Number:  ______

               Trailer-Year: _______ Make: ____ Air Ride: YesNo  Trailer Number:  _____

Driver's Name:  _______________________ Cell Phone Number:  __________________

Person or persons authorized to approve loads for this unit and/or driver. _____________ _____________________________________________________________________

Truck Domicile Location: ___________________________________________________

List any specific lane preferred details: ________________________________________

Preferred type of freight: ___________________________________________________

Minium acceptable rate _______________________________ per mile.

Preferred lanes:  North East South East Midwest West Coast South West

Please complete the Multi Unit Dispatch Sheet if you are a carrier with more than one (1) unit.

Fax Number or eMail Address for billing purposes: ____________________________________

Fax Number or eMail Address to send load info: _____________________________________

I acknowledge that the above information is true and accurate to the best of my knowledge

Name: ______________________________Date:_____________________

Signed: ______________________________