CARRIER SETUP FORM MC# / DOT / Interstate Permit * IEM / SSN / W9 Company Name / DBA Phone Number * First Name * Last Name Address City State/Province Country —Please choose an option—USACanada ZIP/Postal Code Email Insurance Company Insurance Contact Name Insurance Phone Number Name of the Factory Factory Phone Number Number of Drivers Number of Trucks Type of Equipment * —Please choose an option—Dry vanReeferFlat bedStep deckPower onlyBox truck Preferences Kindly upload following documents here: 1. MC Authority Letter 2. W9 Form 3. Certificate of Insurance 4. Notice of Assignment / Voided Cheque By providing a telephone number and submitting this form, you are consenting to be contacted by SMS text message. Message and data rates may apply. Message frequency varies. To stop receiving messages, text STOP; for additional help, text HELP. The privacy policy can be accessed at Privacy Policy I declare the above information to be correct as per my knowledge at the time of Sign Up.