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NexRoute Logistix

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THANK YOUF OR CHOOSING NEXROUTE LOGISTICS. PLEASE FILL OUT THE FOLLOWING INFORMATION TO THE BEST OF YOUR ABILITY. IF THE QUESTION DOES NOT APPLY TO YOU PLEASE ANSWER "N/A" IN THE BLANK SPACE.

FULL NAME*

DATE*

COMPANY NAME OR DBA*

PHONE #*

EMAIL ADDRESS*

PREFERRED METHOD OF CONTACT*

PHONE

EMAIL

MC #*

DOT #*

WHAT TYPE OF TRAILER(S) DO YOU HAVE? (include dimensions & equipment you have)*

HOW MANY TRUCKS DO YOU HAVE?*

DO YOU HAVE A FACTORING COMANY?*

YES

NO

IF "NO" HOW DO YOU INTEND TO GET PAID?

FACTORING COMPANY NAME*

FACTORING COMPANY PHONE #*

DRIVER(S) NAME(S)*

PREFERRED GEOGRAPHICAL LANES*

SOUTHERN STATES

WEST COAST STATES

MIDWEST STATES

SOUTHEASTERN STATES

NORTHEASTERN STATES

ZONES TO AVOID*

ZONE 0

ZONE 1

ZONE 2

ZONE 3

ZONE 4

ZONE 5

ZONE 6

ZONE 7

ZONE 8

ZONE 9

LIST ANY PREFERRED LANE DEATILS*

BREAK EVEN POINT*

MAX LOAD CAPACITY*

EMAIL ADDRESS TO RECEIVE INVOICES FROM NEXROUTE LOGISTIX*

INSURANCE COMPANY NAME (Original Copy of Certificate will be requested)*

AGENT AND CONTACT INFORMATION*

STARTING LOCATION(S)*

HOW LONG HAVE YOU HAD YOUR AUTHORITY*

NexRoute Logistix

NexRouteLogistix@gmail.com

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