Central Auto Dispatch, New Car Loads, Used Car Loads, auto transport loads, car loads, truckloads, vehicle loads, transport loads, auto loads, auto load board, auto auctions loads, car dealers loads

User Information

User Name :	(Check for availability)
User Type :

Contact Information

Company Name:
Company Logo:
Dispatch Contact Person:
Owner or Manager:
Street Address:
City (and Province if applic.*):
State:
Zip:
Phone to List:
Local Phone:
Fax:
E-Mail:
Web Site: http://
Hours of Operation
Timezone:

Reference Information

ICC-MC or Dealer License #:
EIN/Tax ID:
Year Established:
Company Description:

Credit Card Information

Name on Card:
Credid Card No:
Expiration:
CVV Number:

Billing Information

Name:
Address:
City:
State:
Zip:

Carriers please use Broker/Dealer/Auction references - Others use Carrier references

Business Reference #1:
Business Reference #2:
Business Reference #3:

Broker Bond Information (if applicable, otherwise enter 'None')

Surety Bonding Agent:
Bonding Company Phone:

Insurance Information (carriers only)

Insurance Company (Canal, Northland, etc.):
Insurance Company (Agent):
Insurance City/State (Agent):
Insurance Phone (Agent):
Liability Limit:
Cargo Physical Damage Limit:
Insurance Deductible:
Authority Certificate Upload PDF file:
Insurance Copy Upload PDF:
W 9 Form Upload PDF:
ICC-MC or Dealer License #:
Broker MC #:

Equipment and Route Information (carriers only)

Number of Trucks:
Equipment Description:
Route Description:

Member Agreement

I agree to be bound by Terms&Services and understand that after the 30 day FREE TRIAL I will be invoiced for the next 3 months service and that I may CANCEL at any time and owe nothing. New Members: I understand that only Bonded Brokers, Licensed Interstate Carriers, Dealers,Auctions, International Shippers, Salvage Yards, and Corporate Re-Locator\'s who have not previously used CentralAutoDispatch are eligible for the FREE TRIAL.

Others (if accepted) may NOT be offered a FREE TRIAL, but may pay for their first quarter in advance.