Broker Registration for Carrier Onboarding Services

Broker Registration

* indicates required field

"*" indicates required fields

Company Information:

Company Name* Street Address* City* State / Province*Zip / Postal Code* Country*MC Number:* USDOT Number:*

Contact:

Contact Name*

First

Last

Title* Telephone Number:*

Contact Email*

Enter Email

Confirm Email

Contract:

Check this box if same as Contact information above

Name of Person Who Signs Your Agreements

First

Last

Title

Email of Person Who Signs Your Agreements

Enter Email

Confirm Email

Billing:

Desired Monthly Billing Date Example – 1st, 15th, 30th

Once registered, we will send a separate email with a credit card authorization form.

List of Broker Names:

Required*

First NameLast NameEmailConfirm Email Please provide a list of all brokers in your firm. To add additional brokers, click the “+” icon.

Do you have a Group email address?*

Yes

No

If "Yes", what is the email address for your Group?

Enter Email

Confirm Email

Broker Credentials:

Required*Max. file size: 125 MB.Please upload a copy of your broker credentials. This packet should include the following:
Insurance; Certificate of Federal Operating Authority; Surety Bond

Broker Documents / Contracts

Broker Documents*
Drop files here or

Max. file size: 125 MB.

Please upload a copy of your broker agreements. Please include the following: Broker / Carrier Agreement; Schedule of Rates and Changes (if applicable); Early Pay Discount (if applicable); Hazardous Materials Addendum (if applicable); Broker Payment to Carriers process.

Broker Branding:

Company Logo*
Drop files here or

Accepted file types: png, jpg, Max. file size: 125 MB.

Please upload a copy of your company logo in .png or .jpg format