Vendor Profile

Vendor Profile Form

Please complete this, to assist us in identifying your company's services more accurately:

Company Name:
Address:
City:
State:
Zip Code:
Email:

Accounting Office Information (if different)
Address:
City:
State:
Zip Code:
Email:

Operations Manager
Name:
Phone:
Email:
Fax #:

Dispatch Contact
Name:
Phone:
Email:
Fax #:

Rates Contact
Name:
Phone:
Email:
Fax #:

Cargo Insurance Provider
Name:
Phone:

Workers Compensation Insurance Provider
Name:
Phone:

Company Operational Information:

ICC#
Federal ID#
US DOT#
DOT Safety Rating
SCAC Code
CHL# (Customs House License)

Total Trucks
# company owned and operated
# owner operators
# local trucks (50 milesradius)
# regional trucks (round trip any miles)
# one way

Please describe the scope
of your one way service:

Please advise the type of yard you use to secure loads (daily and over an extended
period of time). Please include the size of the yard (number of containers you can
store) and type of security used.

Daily

Extended:

Type of equipment (owned or leased) Check all that apply:
	20' Chassis
	20' Triaxle
	40' Chassis
	40' Triaxle (Super Chassis)

Do you possess the appropriate certificates, permits, and/or expertise to handle the following loads. Check all that apply:
	Hazardous
	Overdimensional
	Bonded
	Overweight
	Reefer
	Liquor

Do you have the capability to retrieve and provide information via the internet and email?

yes no

Additional Branches Information: