Carrier Enrollment

Company Name

Address

Address 2

Phone

Fax

Contact Name

Title

Email

Describe your local pickup and delivery operation. Do you run regular routes delivering and picking up multiple shipments on each truck, or is each shipment handled separately on its own exclusive run?

The types and number of vehicles in your fleet?

Check which of the following you have as standard equipment on your trucks

Check if you have access to the following equipment

Are your drivers uniformed? Yes  No

What is the size of your warehouse?

Check to indicate that you can provide the following:
$500,000 general liability
$100,000 cargo liability
Workers compensation, unemployment and other insurance as may be required by law
Release liability of $.60 per lb. with a $75.00 minimum payout
Excess valuation (surcharge of $.33 per $100)

Hours of operation and after hours contact:

Furnish your normal service area, either by mileage of zip codes. It is preferred the service area be broken down into three categories – daily service zone, secondary zone (less than daily service) and remote areas.

Indicate your claims to shipment ratio:

What is your time limit on filing claims?

Do you have a security cage? Yes  No

Are you certified to handle hazardous materials? Yes  No

Do you have climate control capabilities? Yes  No

Single man capability? 2 man standard?
Additional up to ?

Please supply references (HVP only).