Carrier Application

Carrier Application - CSMI

Thank you for your interest in driving for Central States Manufacturing. To be considered, please fill in the below form in full and a member of our team will be in touch shortly if we have openings or needs that match your area/region coverage.

Carrier (legal name):*

Date Company Started*

Carrier's Physical Address*

(format: 124 Main St, James, MN 88999)

Carrier's Mailing Address*

(format: 124 Main St, James, MN 88999)

Carrier's Office Number*

Phone

Carrier's Mobile Number (if applicable)

Phone

Carrier's Fax Number (if applicable)

Phone

Carrier's Website

Carrier's Email

Contact for After Hours / Emergency

Carrier's MC#*

DOT#*

Are you a broker?*

Yes

Owner Information:

Owner Name*

Ownership Type*

Owner Address

Owner Preferred Phone*

Phone

Owner Email*

Do you need to add additional owner's information?*

Yes

Additional Owner Name*

Additional Owner Ownership Type*

Additional Owner Address

Additional Owner Preferred Phone*

Phone

Additional Owner Email*

Enter any additional owners names, phone, and email address

Fleet and Crew Information

How many trucks do you own?*

How many trailers do you own?*

How many trucks do you rent or lease?*

How many trailers do you rent or lease?*

We require flatbed trailers for our material. Are you able to meet this requirement?*

Yes

Which of the following flatbed trailers do you own/lease? Conestoga, Flatbed with Tarps, Other.*

(please provide full details and a count of each type available. example: 3 Conestoga trailers in my fleet)

Do you have Moffett trailers or access to Moffett trailers?*

Do your drivers have proper training for Moffett use?*

Yes

Do you have your own fleet of drivers?*

Yes

Do you hire drivers per job or allow others to operate under your authority?*

Yes

Do you agree to the following requirements and accept responsibility for communicating this information to your drivers?*

Your driver(s) will be entering Central States Manufacturing, Inc facilities. All persons in the plant must wear full length jeans or pants, steel toed footwear, safety glasses, and safety vest. All persons entering safety restricted areas on the property must wear steel toed footwear and safety vest.

Deliveries of our material are made directly to customers. Professional appearance and proper grooming are expected as your driver will be a representative of our company. Proper footwear, adherence to requirements of proper PPE use/wear, and communicating in a professional manner are minimum expectations.

Yes

Are your drivers familiar with multiple stop deliveries?*

Yes

Will you haul multiple stop/drop deliveries?*

Yes

Do you have a limit on number of drops?*

(if yes, please explain)

Do you have hotshot capabilities?*

Yes

Occasionally we need to collect payment at time of delivery. (FedEx prepaid envelope provided) Are your drivers able to secure payment, send photo of check, then drop at FedEx dropbox/facility?*

Yes

What is geographical area of coverage?*

(you may list states, regions, or lanes)

Is there any specific area you will NOT be able to haul to or from?*

What is your current average rate per mile?*

What is your drop fee?*

What is your detention fee?*

What is your Truck Order Not Used fee?*

What is your COD Pick-up fee?*

What are your other fees?*

(list type of fee and costs associated)

Please describe your availability*

(example: "currently available and for a long-term" or "will only be available in (month)", etc.)

Miscellaneous Information

Do you hire other transportation companies or subcontractors to perform any of your deliveries?*

Yes

Do you offer shippers any tracking capabilities of units?*

Yes

Safety Information

Has your authority ever been revoked by the FMCSA?*

Yes

Please provided all dates and reason for "revoked by the FMCSA"*

(Date Revoked and Reason for each instance)

Has your license ever been revoked or suspended by state/local authority or by the DOT?*

Yes

Please provided all dates and reason for "revoked/suspended by the DOT"*

(Date and Reason for each instance)

Have you (carrier) or any owners filed for bankruptcy protection?*

Yes

Please explain each bankruptcy in the last 10 years*

(Date and Reason for each instance)

Insurance Information

If you have documents to attached, you may do so here.

Drag and drop files here or

I acknowledge that I have the authority from the carrier to complete this document on behalf of the carrier and to verify its accuracy. By selecting yes and submitting this form, I am signing this authority.*

Yes

Send me a copy of my responses

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