CARRIER PACKET

THANK YOU FOR CHOOSING A1 FREIGHT DISPATCH. PLEASE FILL OUT THE FOLLOWING INFORMATION TO THE BEST OF YOUR ABILITY. IF THE QUESTION DOES NOT APPLY TO YOU PLEASE ANSWER "N/A" IN THE BLANK SPACE.

FULL NAME*

DATE*

COMPANY NAME OR DBA*

PHONE #*

EMAIL ADDRESS *

PREFERRED METHOD OF CONTACT*

PHONE

EMAIL

MC #*

DOT #*

WHAT TYPE OF TRAILER(S) DO YOU HAVE? (include dimensions & equipment you have)*

HOW MANY TRUCKS DO YOU HAVE?*

DO YOU HAVE A FACTORING COMPANY?*

YES

NO

IF "NO," HOW DO YOU INTEND TO GET PAID?

FACTORING COMPANY NAME*

FACTORING COMPANY PHONE #*

DRIVER(S) NAME(S)*

PREFERRED GEOGRAPHICAL LANES*

SOUTHERN STATES

WEST COAST STATES

MIDWEST STATES

SOUTHEASTERN STATES

NORTHEASTERN STATES

ZONES TO AVOID

ZONE 0

ZONE 1

ZONE 2

ZONE 3

ZONE 4

ZONE 5

ZONE 6

ZONE 7

ZONE 8

ZONE 9

LIST ANY PREFERRED LANE DETAILS*

BREAK EVEN POINT*

MAX LOAD CAPACITY*

EMAIL ADDRESS TO RECEIVE INVOICES FROM A1 FREIGHT DISPATCH*

INSURANCE COMPANY NAME (Copy of Original Certificate will be requested)*

AGENT AND CONTACT INFORMATION*

STARTING LOCATION(S)*

HOW LONG HAVE YOU HAD YOUR AUTHORITY*

JROBINSON@A1FREIGHTDISPATCHLLC.COM

(617)320-3194 cell

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