Grade A Logistics Application

Date:
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Legal Name of Company
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Registered Trade Name (D.B.A):
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Mailing Address:
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City
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  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Authorized Contact:
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Title:
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Email Address:
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Phone:
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Fill in email to send insurance certificate request to your insurance company:
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Federal Tax ID #:
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MC #:
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US DOT#:
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  • - select a option -
  • Yes
  • No
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Driver information

Driver:
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Truck #:
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Phone #:
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W-9 (must be signed and dated)
Upload your documents...
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Operating Authority and DOT Certificate
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$100,000 Regular Cargo Insurance Required.

$1,000,000 General Liability Required.

$1,000,000 Automobile/Public Liability Required.

$150,000 Refrigerated Cargo Coverage.

Payment delivery method
  • - select a option -
  • EFS Check (Fee: 5% of Invoice)
  • ACH to your Bank Account Next Day (Fee: 3% of invoice)
  • ACH to your Bank Account 30 Days (Free)
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Account
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Account Type:
  • - select a option -
  • Savings
  • Checking
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Account Number:
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Routing Number:
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Attach a voided check:
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Select Office:
  • - select a option -
  • Huntingburg, IN
  • Indianapolis, IN
  • Champaign, IN
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Signature
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Submitting this form with your electronic signature binds you to the agreements listed above