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MC Authority, W-9 and Insurance

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Carrier Set-up

Instructions: Please complete the below form by supplying us with all the needed information that pertains to you and your company. The better informed we are, the better we will be able to assist you. This form can be updated at anytime by notifying us. This information is for our internal use only and will not be released to any third party without your expressed written permission.

Finance Application Form

PART I: CARRIER PROFILE INFORMATION SECTION:

PART II: INSURANCE INFORMATION:

PLEASE NOTE: WE DO REQUIRE OUR CARRIERS TO MAINTAIN A MINIMUM OF $1,000,000 IN LIABILITY INSURANCE AND $100,000 IN CARGO INSURANCE.

PART III: FACTORING INFORMATION:

IF YOU USE A FACTORING SERVICE, PLEASE PROVIDE US WITH THE BELOW INFORMATION. THIS WILL ENSURE THAT WE ONLY USE BROKERS THAT ARE APPROVED BY YOUR FACTORING COMPANY.

PART IV: EQUIPMENT SECTION:

IF YOU USE A FACTORING SERVICE, PLEASE PROVIDE US WITH THE BELOW INFORMATION. THIS WILL ENSURE THAT WE ONLY USE BROKERS THAT ARE APPROVED BY YOUR FACTORING COMPANY.

PART V: SERVICE AREAS OF OPERATION

(SELECT ALL THAT APPLY)

RATE OF HAUL INFORMATION:

PLEASE PROVIDE YOUR MINIMUM RATE INFORMATION.

PART VI: OTHER INFORMATION

PLEASE USE THE FOLLOWING SECTION TO BETTER DESCRIBE YOUR COMPANY. ADDITIONAL INFORMATION WILL HELP US BETTER ASSIST YOUR ORGANIZATION.