Please complete the following form to register your brokerage with FreightForge: * indicates required field Company Information:Company Name*Street Address*Address 2City*State / Province*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonZip*Country*United StatesCanadaMC Number:*Broker Contact Information:Broker Contact Name* First Last Broker Telephone Number:*Broker Contact Email* Enter Email Confirm Email Other Broker Contacts:First NameLast NameEmailConfirm Email (To add additional Lanes, click on the "+" symbol) Upload Your Broker Credentials:Required* Drop files here or Please upload a copy of your Broker Credentials . This packet should include the following: Insurance; Certificate of Federal Operating Authority; Surety BondPricing:Broker Load Dashboard Monthly Fee Price: $9.95 (30-day trial period, then $9.95 each month)Total $0.00 Terms of Use* I agree to the Terms of Use Payment Information:Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name