Dispatch Services Dispatch Services Dispatch Services Applicant Name * First Name Last Name Email * Phone * (###) ### #### Company Name * MC Activation Date * MM DD YYYY MC Number * USDOT Number * Address Address 1 Address 2 City State/Province Zip/Postal Code Country EIN * Equipment Type * Reefer Flatbed Dry Van Hotshot CDL Hotshot NON-CDL Equipment Description Year, make, model, GVWR Number of Units * *For Hotshot only * Trailer length Area of Operation Regional Over the Road (OTR) Zone * Please, list any states you prefer to not travel Factoring Company * if not currently factoring, we can assist Contact Consent * By checking this box you agree to allow NY HOTSHOT to contact you via phone and/or email. Agree I don’t agree Thank you!
