32nd DEGREE LOGISTICS

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First / Last Name*

Business Name

EIN Number (If established)

Business Phone*

Cell Phone*

Fax Number

Email*

Business Address*

Mailing Address (if different from business)

Social Security*

DBA (if different from legal business name)

Dun & Bradstreet #

Are You Currently a Driver?*

Yes No

If Yes, do you Drive for Yourself or for a Company?

Company Myself

If for a Company, Name of the Company?

Have you or your Company ever had a DOT and/or MC#? If Yes, please provide the number.

Number of Vehicles that will be Operated in the US?

What type of Commercial Motor Vehicle will you operate?

What type of Goods will you be Transporting?

How far will you Transport?*