TDS Dispatch Application

• Exact Legal Name of Company*
• Trade Name / DBA*
• DOT Number*
• MC Number*
• Physical Address*

  Address Line 1
  Address Line 2
  City	State
  Zip Code	Country
• Billing Address*

  Address Line 1
  Address Line 2
  City	State
  Zip Code	Country
• Phone Number*

  ### ### ####
• Fax Number*

  ### ### ####
• FEIN*
• TDS Package (Select one)*

  Basic Package

  Full Service Package
• Number of Trucks you own*
• Type of Trailer (Select all that apply)*

  Dry Van	Reefer	Flatbed
  Auto Carrier
• Other*
• Trailer Size*
• Areas of Operations (Select all that apply)*

  AL	AR	AZ
  CA	CO	CT
  DE	FL	GA
  IA	ID	IL
  IN	KS	KY
  LA	MA	MD
  ME	MI	MO
  MN	MS	MT
  NC	ND	NE
  NH	NJ	NM
  NV	NY	OK
  OR	PA	RI
  SC	SD	TN
  UT	VA	VT
  WA	WI	WV
  WY
• Minimum Rate per Mile*
• Maximum Number of Pick Ups per Load*
• Maximum Number of Drop Offs per Load*
• Driver Touch*

  Yes

  No
• Do you require fuel advance?*

  Yes

  No
• Do you authorize giving fuel advances to the driver?*

  Yes

  No
• Max % agree to pay for fuel advance*

  %
• Do you use a Factoring Company*

  Yes

  No
• Factoring Company Address*

  Address Line 1
  Address Line 2
  City	State
  Zip Code	Country
• Percentage Charged by Factoring Company*
• Check Box*

  Option 1	Option 2	Option 3
• Max Percentage agree to pay for Quick Pay*
• Full Name as appears on Credit Card*

  Prefix

  First Name

  Middle Name

  Last Name
• Credit Card Number*
• Check Box*

  Option 1	Option 2	Option 3
• Billing Address associated to Credit Card*

  Address Line 1
  Address Line 2
  City	State
  Zip Code	Country
• Expiration Date*
• CV # (as appears in the back of credit card)*
• File Upload*
• Upload your documents

  Please upload the following documents: MC; CERTIFICATE OF INSURANCE; W-9.
• Agree to Terms and Conditions.*

  Agree
• Security Code*
  

   

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