Transportation Customer Assessment Form

Transportation Customer Assessment Form

Please provide as much of the following data as you have available.
Don’t worry if you don’t have a lot, we will contact you to walk you through it

*indicates required field

Name *

Email *

Company Name *

Address *

City, State, Zip *

Term of Contract (Months)

Days/Week

Billing Address (IF DIFFERENT)

Company Name *

Address *

City, State, Zip *

Pick Up Times

Delivery Times

Origin Zip Code

Freight Classification

NMFC Number

Product Description

Refrigerated Service	Yes No	%
Temperature Range	Yes No
Dry Service	Yes No	%
Inter or Intra state deliveries	Yes No
Annual Weight	Yes No

SERVICE EXPECTATIONS
Delivery to Appointment		%
Delivery to RAD		%

Appointment Scheduling	Yes No
Online	Yes No
POD required	Yes No

204 Motor Carrier Shipment Information	Yes No
210 Motor Carrier Freight Details & Invoice	Yes No
Online Access to Delivery information	Yes No

Other:

Refrigerated Service	Yes No	%
Temperature Range	Yes No
Dry Service	Yes No	%
Inter or Intra state deliveries	Yes No
Annual Weight	Yes No

SERVICE EXPECTATIONS
	Delivery to Appointment	%
	Delivery to RAD	%

Appointment Scheduling	Yes No
Online	Yes No
POD required	Yes No

204 Motor Carrier Shipment Information	Yes No
210 Motor Carrier Freight Details & Invoice	Yes No
Online Access to Delivery information	Yes No

Distance Determiner	Yes No

Other:

Refrigerated Service	Yes No	%
Temperature Range	Yes No
Dry Service	Yes No	%
Inter or Intra state deliveries	Yes No
Annual Weight	Yes No

SERVICE EXPECTATIONS
Delivery to Appointment		%
Delivery to RAD		%

Appointment Scheduling	Yes No
Online	Yes No
POD required	Yes No

204 Motor Carrier Shipment Information	Yes No
210 Motor Carrier Freight Details & Invoice	Yes No
Online Access to Delivery information	Yes No

Other: