Agent Profile  Business Name: Business Status: Corporation Independent Contractor Address: City: State: ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST. OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON OTHER PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING ALBERTA - CANADA BRITISH COLUMBIA - CANADA MANITOBA - CANADA NEW BRUNSWICK - CANADA NEWFOUNDLAND AND LABRADOR - CANADA NORTHWEST TERRITORIES - CANADA NOVA SCOTIA - CANADA NUNAVUT - CANADA ONTARIO - CANADA PRINCE EDWARD ISLAND - CANADA QUEBEC - CANADA SASKATCHEWAN - CANADA YUKON - CANADA    Zipcode:   Telephone: --    Ext:   Fax: --    Nextel:  -- Company website: Hours of Operation Days:     Hours:   Weekend contact: Owner / CEO Name: Phone: -- Fax: -- Email:   Senior Operations Manager Name: Phone: -- Fax: -- Email:   Dispatch Manager Name: Phone: -- Fax: -- Email:   Accounting Manager Name: Phone: -- Fax: -- Email:   Emergency Contact Name: Phone: -- Fax: -- Email:   Dispatch Information Please enter in the email addresses for at least two people who will receive daily order alerts and jobs from the NSD operations group Email: Email: Email: Company Profile Office Location: City: State: ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST. OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON OTHER PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING    Zipcode:   Telephone: --    Fax:  -- Office Manager: Total # of office staff: (non drivers) Total # of drivers: Hours of Operations:   Warehouse Location: City: State: ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST. OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON OTHER PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING    Zipcode:   Telephone: --    Fax:  -- TSA Certified: Yes No Smartway Certified: Yes No Dock Manager: Total # of dock workers: (non drivers) Total # of drivers: Hours of Operations: Total space: (square footage) Is your warehouse climate controlled? Yes No Loading dock: Yes No Forklift on site: Yes No Do you Recycle Cardboard? Yes No Mode of Transportation   1. Personal vehicles (car, pick up trucks, mini van): Yes No   Total # of personal vehicles:   Average age of equipment (5 years, 3 years, etc.):     2. Cargo van (9ft or greater): Yes No   Total # of Cargo vans:   Average age of equipment (5 years, 3 years, etc.):     3. Box / straight trucks without lift gate: Yes No   Length of box truck: 14  16  18  20  24  26     Other:    Total # of box trucks:   Average age of equipment (5 years, 3 years, etc.):     4. Box / straight trucks with lift gate: Yes No   Length of box truck: 14  16  18  20  24  26     Other:    Total # of box trucks:   Average age of equipment (5 years, 3 years, etc.):     5. Tractors - over the road sleepers (power units): Yes No   Total # of Tractors:   Average age of equipment (5 years, 3 years, etc.):     6. Tractors - day cabs (power units): Yes No   Total # of Tractors:   Average age of equipment (5 years, 3 years, etc.):     7. Dry van trailers: Yes No   Length of dry vans: 23  28  40  48  53     Other:    Total # of dry van trailers:   Average age of equipment (5 years, 3 years, etc.):     8. Flatbed trailers: Yes No   Length of flatbeds: 23  28  40  48  53     Other:    Total # of flatbed trailers:   Average age of equipment (5 years, 3 years, etc.):     9. Reefer trailers: Yes No   Length of reefer trailers: 23  28  40  48  53     Other:    Total # of reefer trailers:   Average age of equipment (5 years, 3 years, etc.):     10. Other specialized equipment (stair climbers, etc.): Yes No   List equipment:   Total # of reefer trailers:   Average age of equipment (5 years, 3 years, etc.): Industries of Interest   1. Appliances (washers, refrigerators) Yes No   Installation service (hook up / removal) Yes No     2. Electronics (Plasma TV’s, big screens) Yes No   Installation service (hook up / removal) Yes No     3. Pharmaceuticals / Medical Yes No     4. Furniture (couch, bedroom sets) Yes No   Assembly Services Yes No     5. Envelops / small packages Yes No     6. Perishable goods (food, flowers) Yes No Current Service Options   1. Same day hotshot services Yes No   2. Next day delivery services Yes No   3. Weekend delivery service Yes No   4. After hour delivery service Yes No   5. Installation, Assembly & Complex Services Yes No   6. COD or payment services (upon delivery) Yes No   7. Holiday delivery service Yes No   Submit

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