Contact Name (Required):
Contact Phone Number (Required):
Email Address (Required):
Effective Date
Trucking Operations
List of Commodities HauledAverage ValueMaximum Value% of Total Hauls
Radius of Operations:        
Percentage of Trips:        
General Information
Do you haul any hazardous or extrahazardous substances as defined by the Environmental Protection Agency (EPA)?
If yes, please explain:
Do you allow passengers?Do you act as a freight forwarder, broker, or arrange loads for others?
Projected Yearly Receipts $Projected Yearly Payroll $
Route Information
Normal operating radius? miles Longest one-way trip? miles
Driver Information
Are all drivers required to have a CDL for at least 2 years?
Do all drivers get road tested?
Are MVRs checked before hiring drivers?

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The Loomis Company | 850 N Park Rd | Wyomissing, PA 19610 | 610.374.4040