Customer Contract Negotiation Information "*" indicates required fields Agent Owner First Name* Agent Owner Last Name* Agent #* Agent Phone #* Agent Email* Agent relationship to customer* Can UACL contact the customer directly should additional questions come up in relation to the contract?* Yes No Explain why contact cannot be initiated* Customer Name* Customer Contact Name* Customer Contact Phone* Customer Contact Email* Projected Annual Revenue*1-25K25-100K100-500K500K +Initial Load Pickup Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Initial Load Pickup Time* Hours : Minutes AM PM AM/PM Additional lane notes/commentsIs this direct shipper freight?* Yes No What lane(s) does this cover?* Please provide broker MC# Is this project freight?* Yes No Number of loads per month this opportunity would present?* What is the commodity being hauled?* Will this freight be moved on UACL asset trucks or be brokered out? Asset Trucks Only Brokers Other Please explain other*Are there backhaul opportunities available?* Yes No Please advise of the customer and the lane(s)*Please upload the contract or supply any supporting documentation below Drop files here or Select files Accepted file types: pdf, ppt, pptx, doc, docx, Max. file size: 5 MB, Max. files: 10. If there is no contract to upload, please place the RMIS, MyCarrierPackets/AssureAssist, DAT Onboarding, Highway, or other access point link below. CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
