CARRIER PROFILE General Information: Carrier Name: SCAC Code: State Incorporated: Type of Company: PublicPrivateLLCOwner/Op If private, owners name: Tax ID Number: MC #: DOT #: Hazmat Reg. #: Current DOT safety rating of Satisfactory: Yes    No Rating Date:   Mailing Address: City: State/Province: Zip/Postal: Physical Address: City: State/Province: Zip/Postal:           Remit To: City: State/Province: Zip/Postal: Insurance:   Indicate per occurrence amounts.   Copy of certificate(s) will be required. Cargo: General Liability: Auto: Worker's Comp: Umbrella Rider: Insurance Carrier: Contact Information: Operations: Name: Phone: Email: Role: Name: Phone: Email: Role: Name: Phone: Email: Role: Management: Name: Phone: Email: Role: Name: Phone: Email: Role: Accounting / Billing: Name: Phone: Email: Role: Emergency Contact: Name: Phone: Hours: Drivers: # Company Drivers: # Owner Operators: Driver turnover ratio (last year): % Power Units: # Company Tractors: # Company Trucks: Teams: In-cab communications: Satellite   Cell Phone   Other (specify)   Trailers and Truck Equipment: Type Number Length     Type Number Length     Type Number Length Dry Van     Flat Bed     Dry Trucks Refrigerated Van     Other     Refrigerated Trucks Primary Geographic areas of Operations:  (check all that apply) Mid-Atlantic South East North East Mid West North West South West Canada Mexico CA TX FL Metro NY Preferred Backhaul Destinations:  (Please tell us about your backhaul lanes, type of equipment, frequency) Origin Area Destination City St/Prov Equipment & Other Info Lane 1 Lane 2 Lane 3 Lane 4