Carrier Onboarding – Ship Tall Pines

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Carrier Onboarding Form

Carrier Profile

MC# *

DOT# *

Fed ID# *

SCAC Code *

Company Name *

DBA *

Physical Address *

City

State

ZIP

Mailing Address *

City

State

ZIP

Phone *

Toll Free

Fax

Dispatch Contact *

Email *

Phone *

Cell

Operations Mgr *

Email *

Phone *

Cell

After Hours Contact *

Email *

Phone *

Cell

Authority Status: Common

Contract

Broker

C-TPAT Member

Number of trucks

Number of trailers

Do you run CNG trucks? *YesNo

Types of trailers: V53

R53

FB

Step Deck

Power Only

LTL

DD

RG

Do you run teams? *YesNo

E-Track

Partial LTL

Other

Do you have hazmat drivers? *YesNo

Certification Number

Expiry Date

Do you have drop trailers? *YesNo

Do you serve Mexico? *YesNo

Do you serve Canada? *YesNo

Insurance Company *

Agent Name *

Phone *

Fax

Email *

Factoring Company *

Phone *

Fax

Address *

City

State

ZIP

In order for Tall Pines Transportation and Logistics to comply with tier two data requirements, please mark the following that apply to you. If none of the options below apply to your company, please leave blank.

Minority Business EnterpriseWomen Business EnterpriseSBE (Small Business Enterprise)DBE (Disadvantaged Business Enterprise)Disabled Business EnterpriseSmall Business (HUBZone)VOB (Veteran Owned Business)

Signature *

Name *

Date

Please upload: W-9 *

No file chosen

MC Authority Document *

No file chosen

Certificate of Insurance *

No file chosen

Voided Check

No file chosen

Yes, I agree with the terms and conditions.