Carrier Application

Company name*

Contact name*

Email*

Phone*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Social media account

Website

Year/Make/Model of Equipment*

Open or Enclosed Trailer?*

Open

Enclosed

Trailer Capacity*

1 Car

2 Cars

3 Cars

4 Cars

5 Cars

6 Cars

7 Cars

8 Cars

9 Cars

Travel Routes*

Intrastate

Interstate

List All Authority Numbers ex. Dot#, MC# and CA#?

Years in Business?

Certificate of Insurance (Upload current COI)

Upload copy of driver license/ Class A or B and DMV record.

Upload left and right pictures of truck with authority numbers visible.

Upload Current Medical Card

Rates- what rate do you charge per mile?

Do you offer flat rates?

Hitch Type:

Fifth Wheel

Gooseneck

Disclosure- *Must carry proper limits of insurance at all times.

GQ Auto Connect

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