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Request a Carrier Packet

Please fill out the form below to receive our Carrier Packet. For questions about this form call 913-888-1685.

* Required fields

1. Company Information
* Carrier Name:
* Mailing Address:
Physical Address
(if different from above):

2. Contact Information
* First Name:
* Last Name:
* Title:
* Phone:
* E-mail:
3. Business Information
* Motor Carrier (MC) #:
* SCAC Code:
* Years in Business:

Affiliated Companies
& Relationship:

1.

2.

3.

4.

5.


* Preferred Lanes:

1.

2.

3.

4.

5.

4. Insurance Information
Cargo Insurance Amount: U$
Are you HazMat Certified?
Yes No
Are you C-TPAT Certified?
Yes No

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