Carrier Profile Online Form

Company Name *

MC#

DOT#

Street *

City *

Province / State *

Postal/Zip Code *

Country *

Email *

Phone Number *

Fax Number

Name of Owner(s)/President: *

Name of Dispatcher(s)

Referred by

Company Name

Contact Name

Broker/Customer References (Please provide at least three):

Company Name

Address

Account Contact Name:

Phone

Fax

Company Name

Address

Account Contact Name:

Phone

Fax

Company Name

Address

Account Contact Name:

Phone

Fax

Please Attach These Documents

Copy of Cargo Insurance Including Policy Exclusions Page

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Copy of Automobile Liability Insurance

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Commercial General Liability Insurance

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Copy of Workers Compensation Letter of Good Standing

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Copy of National Safety Code Certification

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Copy of Registration

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Current ARBER Certification for TRUs Running In California.

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The undersigned authorizes United World Cargo Limited to obtain trade and bank references as indicated in the application.

Digital Signature (Please type your full name) *

Date *

Carrier Profile Online Form was last modified: January 10th, 2018 by admin1

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Carrier Profile Online Form

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