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Member Sign-Up Page Graphic Thursday, March 11, 2010
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>>Main Contact Information
First Name: Telephone:
 -  -  ext.
Last Name: Fax:  -  -
Title: Email:
>>Company Information
Company Name:   Year Founded:
DBA
(Doing Business As):
Mailing Address:  
City:
State: Zip: 
MC #: DOT #:  
Are you currently leased on to another company?
Number of Company Owned Trucks:
Number of Owner Operator Trucks:
Number of Trailers:
>>Fleet Profile
Type of Business (total should equal 100%)
Truckload: % LTL: %
Total:  %
Construction: % Logging: %  
Brokerage/Logistics: % Farm/Grain: %
Dump/Ready Mix: % Waste/Sanitation: %
Moving & Storage: % Other: %
Moving Agent For:
 
 
Please Check All That Apply
Service Coverage:
Make of Trucks in Fleet:



Type of Trailers in Fleet:



Preferred Tire Brands:



Preferred Retreads:
How do you currently purchase your fuel?





 
How did you hear about TruckersB2B?
 
TruckersB2B reserves the right to decline or terminate your membership at any time. Rebates and Discounts are subject to change.
Sign-Up Options
 

Sign-up online by using the form to the left.
Print the application and fax back to 1.888.855.9633.
Call 1.888.937.6334 to sign-up over the phone.

 
     
1.888.937.6334
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