DISPATCH SERVICE INQUIRY

DISPATCH SERVICE INQUIRY FORM

Thank you for your interest in partnering with JIMMY JAS Dispatching, LLC for our top tier dispatch services. Please complete the form below and one our Dispatch Consultants will contact you shortly.

First Name*

Last Name*

D/O/B

Company Name*

EIN #*

Primary Phone*

Primary Email*

Address

Address Line 1*

Address Line 2

City

State / Province

ZIP / Postal Code

MC#*

USDOT#*

Do you have a TWIC Card?

Are you HAZMAT Certified?

Is your authority more than 6 months old?

How many Commercial Vehicles do you lease/own/ or rent?*

Do you currently factor your loads?

Who do you currently factor with?

Do you currently use fuel cards? (Atob, BP, etc)

Are you looking to travel OTR, Regional, or Local?

Are you willing to stay on the road for 1-2 weeks at a time?

Do you have a smartphone with a good service provider?

What is your desired RPM?

What is your desired gross per week?*

What is your social media handles? (Facebook, Instagram etc)

Website

What are your goals for your business?*

Are you currently working with a Dispatcher?

How soon are you looking to start dispatch services?*

Please tell us how we can EXCEED your expectations!*

How did you hear about us? If referred by who?*

Official Authority Letter

Certificate of Insurance? (COI)

Notice of Assignment (NOA)

Direct Deposit Form/Voided Check

Download y our Direct Deposit Form Here

Driver License or CDL

W-9 Tax Form

Signature

Please sign here

PLEASE NOTE:

COMPLETING THIS FORM DOES NOT FINALIZE THE ONBOARDING PROCESS FOR DISPATCH SERVICES.

AFTER COMPLETING THIS FORM A DISPATCH CONSULTANT WILL BE IN CONTACT WITH YOU VIA EMAIL TO SCHEDULE A TIME SPEAK FURTHER.

WE LOOK FORWARD TO PARTNERING WITH YOU AND ASSISTING YOU WITH TAKING YOUR BUSINESS TO THE NEXT LEVEL!

Make an Appointment: You will be able to choose from available Appointments on the next step

GREAT! Your appointment with {{appointmentTypeStaffNames[appointmentSelectedCalendar]}} is scheduled!

Are you the primary decision-maker for your business?*

Do you need to add the decision maker?

Primary decision maker's information

DISPATCH SERVICE INQUIRY

DISPATCH SERVICE INQUIRY FORM

Signature

{{appointmentSelectedDateView}}

{{appointmentSelectedTimeZoneText}}