Information obtained in this form shall be treated as confidential and will not be distributed or disclosed. First Name *Last Name *Email *Phone: *State: *What is your current position? Agent (1099)Employee (W-2)Owner (Self Employed)Non-Agent Industry ExperienceOtherDescribe all past and present work experience *How many years of freight brokerage experience do you have? *How many years of transportation experience do you have? *Do you have a customer following? *YesNoHow many loads per week? *Gross profit the last 12 months? *Gross sales the last 12 months? *Profit margin per load? *PhoneSubmit
