Thank you for choosing Highway Diva Logistics. Please fill out the following information to the best of your ability. If the question does not apply to you please answer "N/A" in the blank space.

Full Name

Date

Company Name or DBA

Phone #

Email Address

Preferred method of contact

Phone

Email

MC#

DOT #

What type of Trailer(s) do you have? (include dimensions & equipment you have)

How many Trucks do you have?

Do you have a Factoring Company?

Yes

No

If "NO", How do you intend to get paid?

Factoring Company Name

Factroign Comapany Phone #

Driver(s) Name(s)

Preferred Geographical Lanes

Southern States

West Coast States

MidWest States

SouthEastern States

NorthEastern States

Zones to AVOID *

Zone 0

Zone 1

Zone 2

Zone 3

Zone 4

Zone 5

Zone 6

Zone 7

Zone 8

Zone 9

List any preferred Lane details

Break Even Point

Max Load Capacity

Email Address to receive Invoices from HIGHWAY DIVA LOGISTICS

Insurance Company Name (Copy of Original Certificate will be requested)

Agent and Contact Information

Starting Location(s)

How long have you had your Authority?

Thanks for submitting!

Highway Diva Logistics will follow up with you soon!

highwaydivalogistics@gmail.com

Atlanta, GA 30329

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Thank you for choosing Highway Diva Logistics. Please fill out the following information to the best of your ability. If the question does not apply to you please answer "N/A" in the blank space.