CarriersCarrier PartnersCarrier QualificationPayment F.A.Q.Must be completed by an Officer or Authorized Company Representative. Carrier Region NortheastMidwestSoutheastSouth CentralGreat PlainsWest CoastNortheast: Maine, Vermont, New Hampshire, Rhode Island, Massachusetts, Connecticut, New York, New Jersey, Delaware, Maryland, Virginia, Pennsylvania (East of Altoona, PA), Quebec, New Brunswick, Newfoundland and Labrador, Nova Scotia, Prince Edward IslandMidwest: Michigan, Ohio, Indiana, Illinois, Kentucky, West Virginia, Pennsylvania (West of Altoona, PA), OntarioSoutheast: Tennessee, North Carolina, South Carolina, Georgia, FloridaSouth Central: Texas, Oklahoma, Arkansas, Louisiana, Mississippi, AlabamaGreat Plains: Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, Kansas, New Mexico, Colorado, Utah, Wyoming, Idaho, MontanaWest Coast: Washington, Oregon, California, Nevada, Arizona, British Columbia, Alberta, Saskatchewan, Manitoba, Yukon, Northwest Territories, NunavutCarrier Name Trade D/B/A Names Contact Name Dispatchers Phone (Toll-Free) # Phone (Local) # Phone (After-Hours) # Fax # Document Fax # Remit to or Factoring Company Contact Name Remit to Phone # Billing Fax # Safety Contact State of Incorporation or Organization MC # DOT # Federal EIN # FMCSA Rating SatisfactoryConditionalUnsatisfactoryNot RatedIf FMCSA rating is Conditional, Not Rated, or recently changed, please explain: Max Net Cargo Weight (lbs) Provide advances (ComChecks) to drivers/office for operating expenses (fuel, tolls)? YesNoProvide advances (ComChecks) to your drivers for Lumper fees? YesNoVans # Reefer # Flatbead # Bonded? YesNoHazMat Certified? YesNoSmartWay Certified? YesNoCanada? YesNoMexico? YesNoIntrastate? YesNoWarehousing? YesNoEDI Tracking? YesNoDrop Pools? YesNoName Title Email By checking this box, I hereby digitally sign for and verify that all information provided in this Carrier Profile is complete and accurate to the best of my knowledge and belief.