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Registration

Main Contact Information
First Name: Telephone:
 -  -  ext.
Last Name: Fax:  -  -
Title: Email:
Company Information
Company Name:   Year Founded:
DBA
(Doing Business As):
Mailing Address:  
City:
 
State: Zip: 
MC #: DOT #:  
Number of Company Owned Trucks:
Number of Owner Operator Trucks:
Number of Trailers:
Are you leased by another company?
Fleet Profile
Type of Business (total should equal 100%)
Total: %
Truckload: % LTL: %
Construction: % Logging: %  
Brokerage/Logistics: % Farm/Grain: %
Dump/Ready Mix: % Waste/Sanitation: %
Moving & Storage: % Other: %
Moving Agent For:
 
 
Please Check All That Apply
Service Coverage:
Make of Trucks in Fleet:





Type of Trailers in Fleet:




Preferred Tire Brands:






Preferred Retreads:


How do you currently purchase your fuel?







What, if any, brand of oil do you purchase?




 
How did you hear about TruckersB2B?
 
TruckersB2B reserves the right to decline or terminate your membership at any time. Rebates and discounts are subject to change.

While there is no cost to join TruckersB2B, we do charge a $12 check processing fee when an actual rebate check is issued to help cover the cost of processing your information and mailing your rebate check. This fee is deducted from your total rebate amount, it is not cumulative, and you will never owe TruckersB2B anything. If the check processing fee is larger than your actual rebate, you simply will not receive a rebate that month. If you do not receive a rebate in a given month, you are not charged anything.

    
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