Trucking Company Sign Up Form
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TRUCKERS MALL
P.O. BOX 137
PONTIAC, IL 61764

Submit or Fax this form to: 1-815-998-2562

Contact Information:

Name:

Title:

If Other please specify:

Address:

City:

State: Zip Code:

Phone Number:

Fax (if available)

email:
General Information:


LIST YOUR ROUTES AND/OR REGIONS TRAVELED:

A. Over the Road (List States):

B. Regional (List Best Description of Area):

C. Local (List Cities and Towns):

D. Dedicated Logistics (List From Point A to Point B):

Mileage per Month/Annually:

Type of hauling:

If Other please specify:


Year of Equipment (Tractors/Trailers):


Type of Vans:

Length of Trailers or Straight Trucks:

Length of Contract:

Are you interested in mudflap advertising?


DRIVERS

1. MUST HAVE CLEAN OR GOOD MVR

2. TRUCK(S) MUST BE UPKEPT AND IN GOOD REPAIR

3. PROOF OF OWNERSHIP AND INSURANCE

4. MILEAGE / NUMBER OF DAYS PER WEEK OPERATED

5. MUST BE MOSTLY DAYLIGHT HOURS





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Use your browser's BACK button to return.

Fax this form to: 1-815-998-2562