CARRIER PROFILE

Instructions. Please complete this form giving us all the information that pertains to you and
your company. The better informed we are the better we will be able to assist you. This form
should be updated at any time by notifying us. This information is for our use only and will not
be released to any third party without your express written permission.

PART 1: CARRIER INFORMATION SECTION

COMPANY: _________________________________ DBA (if Any) _________________________
PHYSICAL ADDRESS ____________________ CITY ___________ STATE_________ ZIP_________
MAILING ADDRESS: ____________________ CITY ___________ STATE_________ ZIP_________
MAIN CONTACT: ______________________ E-MAIL: ___________________________________
OFFICE PHONE: _______________ FAX: __________________ CELL PHONE ________________
EMERGENCY CONTACT: ___________________ EMERGENCY PHONE: _____________________

PART 2: EQUIPMENT SECTION

NUMBER OF TRUCKS: _________ COMPANY_______________________________
NUMBER OF TRAILERS: ________ VAN: ______ REEFERS: ______ FLATBED ______
Other Types: ___________________________________________________________________

TRAILER SIZE: VAN: ______ REEFERS: ______ FLATBED ______

PLEASE LIST THE BROKERS THAT YOU ARE ALREADY SET UP/APPROVED WITH BELOW:

______________________________________________________________________________
 DISPATCH SPECIFICATIONS
Rate of Haul information: Please give us your minimum cents per mile information. We
understand that many factors will change this information, but this will give us a starting point.
MINIMUM RATE PER MILE: ____________ Max Picks: ____________ Max Drops: ____________
Driver Touch (Y/N): _____ Mountains? (Y/N) _____ Tolls? (Y/N) _____ Weight limit __________

Areas of USA you like to travel (ZONES) – Please circle/check all that apply
Northeast (NY, NJ, CT, RI, MA, ME, etc.)
Midwest (MI, OH, KY, IN, IL, WI, etc.)
Southeast (FL, GA, LA, AL, etc.)
West (CA, AZ, OR, NV, ID, etc.)

COMMENTS: _______________________________________________________

Note: Max Picks demotes maximum pickups from Shippers. Max Drops denotes maximum
deliveries to Receiver.