Charger Carrier Profile

CONTACT PROFILE
*CARRIER NAME: *CHARGER RATING:
*ADDRESS:

, DO NOT USE REASON:

*PHONE:
ALT PHONE 1:
ALT PHONE 2:
FAX:
AFTER HOURS FAX:
TOLL FREE:
IN BUSINESS SINCE:
HAS MINORITY STATUS:
WEB SITE:
*CONTACT 1:
CONTACT 2:
CONTACT 3:
ON CALL USER 1:   Contact Info:
ON CALL USER 2:   Contact Info:

Monday-Friday Hours of Operation:
Saturday Hours of Operation:
Sunday Hours of Operation:
Nearest Airport(s):

ACCOUNTING PROFILE
FACTORING COMPANY (If applicable)
  ACCOUNTS PAYABLE
Company Name: *Accounts Payable Name:
Company Address: *Accounts Payable Email:
City, ST Zip *Accounts Payable Phone:
Company Phone: *EIN#:
Contact Name: *W-9/W-8 BEN:
Contact Email: *Epay Player:

COMPLIANCE PROFILE
Can Move US Domestic Freight:
Can Move Can. Domestic Freight:
Can Move International Freight:
Can Move Mex. Domestic Freight:
*Authority:
Documents
View Add On
File
U.S. DOT Reference:
*MC Number 1:
MC Number 2:
CVOR Number:
*SCAC Code 1:
SCAC Code 2:
CAAT Code (MX):
*Carrier411 Due Diligence Cert: Review Date:
Can Cross US/CAN Border:
*FMCSA Safety Rating

INSURANCE PROVIDERS INFORMATION
*Producer
*Broker Name:
*Broker Address:
*Broker City:
*Broker State:
*Broker Zip:
*Broker Phone:
*Broker Fax:

*Insurance Table
Cert Holder    Appr. Date    Exp. Date    Policy/Ref #    Coverage View Add On File

   Gen Liability

   Auto Liability - -

   Cargo Liability - -

   Workers Comp

Security Compliance Table

Approved    Appr. Date    Exp. Date    Policy/Ref #    View Add On File

CTPAT

FAST

CSA

Smart Way

TSA

EQUIPMENT PROFILE
Has Van Ramp: Has Cross Dock:   Xdock Notes:
Team Service: Has Warehouse Space:        with Size:
Has Blankets: Has Straps:
Has Load Bars: Has E-track:
Roller Beds: Has Fork Lift:
Satellite Equipped: Satellite Provider:
Lift Gates:

Vans:
Modes

Expedite Truckload Expedite Truckload Flatbed
LTL Express LTL Local P&D Courier
Dom. Air Frt. Int'l Air Frt. Next Flight Out Air Charter
Hazmat Refrigerated Specialized Curtain Side
Hand Carry

Small Straight:
Large Straight:
Tractors:
Reefers:
Flatbeds:

COVERAGE PROFILE
PRIMARY SERVICE AREA: SECONDARY SERVICE AREA:

U.S.
AK AL AR AZ CA CO CT DC DE FL
GA GU HI IA ID IL IN KS KY LA
MA MD ME MI MN MO MS MT NC ND
NE NH NJ NM NV NY OH OK OR PA
PR RI SC SD TN TX UT VA VT WA
WI WV WY
CANADA
AB BC MB NB NL NS NT ON PE QC
SK YK YT
MEXICO
AG BJ BS CH CI CL CP CU DF DG
EM GJ GR HG JA MH MR MX NA NX
OA PU QA QR SI SL SO TA TL TM
VZ YC ZT

U.S.
AK AL AR AZ CA CO CT DC DE FL
GA GU HI IA ID IL IN KS KY LA
MA MD ME MI MN MO MS MT NC ND
NE NH NJ NM NV NY OH OK OR PA
PR RI SC SD TN TX UT VA VT WA
WI WV WY
CANADA
AB BC MB NB NL NS NT ON PE QC
SK YK YT
MEXICO
AG BJ BS CH CI CL CP CU DF DG
EM GJ GR HG JA MH MR MX NA NX
OA PU QA QR SI SL SO TA TL TM
VZ YC ZT
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