CARRIER PACKET

THANK YOU FIR CHOOSING NBC TRUCK DISPATCHING. 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

NORTH EASTERN STATES

Multi choice*

ZONE 0

ZONE 1

ZONE 2

ZONE 3

ZONE 4

ZONE 5

ZONE 6

ZOND 7

ZONE 8

ZONE 9

LIST ANY PREFERRED LANE DETAILS*

BREAK EVEN POINT*

MAX LOAD CAPACITY*

EMAIL ADDRESS TO RECEIVE INVOICES FROM NBC TRUCK DISPATCHING*

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

AGENT AND CONTACT INFORMATION*

STARTING LOCATION(S)*

HOW LONG HAVE YOU HAD YOUR AUTHORITY?*

Nbctruckdispatching@gmail.com

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