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Acme Pre-Qualification Form

I am interested in becoming an Acme Trucker.

Please fill this form out as completely as possible, his information is held in the strictest confidence and will not be released or used other then to contact you in regard to this submittal.

What I want most is:
If my truck were a person, it would be:

Last Name:
First Name:
Address:
City:
State:
Zip/Postal:
Phone:
Cellphone:
Fax:
Email:

Are you a fleet owner? Yes No
Number of tractors:
Number of trailers:
Do you know any agents/truckers currently leased to Acme? Yes No
If yes, please list:

* Number of Moving Violations in the Last 3 Years:
* Number of Chargeable Accidents in the Last 3 Years:
* Number of Employers in Last 3 Years:
Choose the service(s) you are most interested in representing?

How did you hear about this business opportunity?
If Other or Link from Another Internet Site:
*-Required Fields

 

 



 
  Acme Truck Line, Inc. • 121 Pailet Dr. Harvey, LA 70058 • P: 504-368-2510 • TF: 800-825-6246