MitchPath Logistic LLC | Contract Carrier Application

Carrier Information

Provide the main carrier and applicant information.

First Name * Last Name * Phone * Email * Last 4 SSN / Tax ID * Position Applying For Legal Business Name * DBA Name

Contact Information

Provide the main contact and business address information.

Street Address * City * State * ZIP Code * Emergency Contact Name Emergency Contact Phone

Business Details

This section helps us understand your company structure.

Business Type * EIN / Tax ID Years in Business * Number of Drivers Number of Vehicles Are you currently active and operating? *

Equipment Information

List the equipment you have available for contracted work.

Equipment Type * Vehicle Year * Vehicle Make * Vehicle Model * VIN License Plate Number Max Load Weight Capacity Liftgate Available? *

Operating Authority

Provide authority and registration details if applicable.

DOT Number MC Number Do you have active operating authority? * Authority Status Registered State Business License Number

Insurance Information

Contract carriers may be required to maintain active insurance coverage.

Insurance Provider * Policy Number * Policy Expiration Date * Liability Coverage Amount Cargo Coverage Amount Can MitchPath Logistic LLC be added as certificate holder if required? *

Service Area

Tell us where you are willing and able to operate.

Home Base City * Home Base State * Preferred Route Type * States Willing to Operate In * Availability * Earliest Available Start Date *

Safety & Compliance

Confirm your ability to follow safety, route, insurance, and customer-service expectations.

Any preventable accidents in the past 3 years? * Any major violations in the past 3 years? * Are you able to meet delivery deadlines and communicate delays? * Are you able to maintain safe vehicle condition? * Explain any accidents, violations, safety concerns, or special circumstances.

Required Uploads

Upload fields are included for applicant review.

Driver License Upload Insurance Certificate Upload W-9 Upload Vehicle Registration Upload DOT / MC Authority Document Upload Additional Document Upload

Review & Agreements

Please read each statement carefully before continuing. This application is for contract carrier consideration only.

I certify that all information provided in this application is accurate, complete, and submitted truthfully. I understand this is a Contract Carrier Application and not an employee application. I understand that insurance, authority, equipment, safety history, and business documentation may be reviewed. I authorize MitchPath Logistic LLC to contact me regarding this application.

Signature & Submit

Complete your electronic signature below.

Full Legal Name * Electronic Signature * Date * Final Notes

I agree that my typed name and electronic signature are legally valid for this Contract Carrier Application.

Congratulations!