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[{"lid":"1548948656203","ls":"10","loff":"","li_type":"tx","li_text":"<div style=\"font-size:22px;font-family:'OpinionPro';\" data-customstyle=\"yes\"><strong>Company Information<\/strong><\/div>"},{"lid":"1549395310400","ls":"20","loff":"","li_type":"in","li_name":"company-name","li_title":"Company Name","li_req":"y","li_nm":"company-name"},{"lid":"1548948777270","ls":"30","loff":"","li_type":"in","li_name":"owners-name","li_title":"Owners Name","li_req":"y","li_nm":"owners-name"},{"lid":"1548948975139","ls":"40","loff":"","li_type":"em","li_name":"email","li_title":"Email","li_ph":"sample@sample.com","li_req":"y","li_nm":"email"},{"lid":"1548949095951","ls":"50","loff":"","li_type":"ph","li_name":"phone-office","li_title":"Office Phone Number","li_ph":"(555) 555-5555","li_req":"y","li_nm":"phone-office"},{"lid":"1549300798429","ls":"60","loff":"","li_type":"ph","li_name":"cell-phone","li_title":"Cell Phone Number","li_ph":"(555) 555-5555","li_req":"y","li_nm":"cell-phone"},{"lid":"1549300814544","ls":"70","loff":"","li_type":"ph","li_name":"fax-phone","li_title":"Fax Number","li_ph":"(555) 555-5555","li_req":"y","li_nm":"fax-phone"},{"lid":"1548949080794","ls":"80","loff":"","li_type":"in","li_name":"dispatch-contact","li_title":"Dispatch Contact","li_req":"y","li_nm":"dispatch-contact"},{"lid":"1549395374952","ls":"90","loff":"","li_type":"tx","li_text":"<div style=\"font-size:22px;font-family:'OpinionPro';\" data-customstyle=\"yes\"><strong>Business Address<\/strong><\/div>"},{"lid":"1549395433813","ls":"100","loff":"","li_type":"in","li_name":"business-address-1","li_title":"Address 1 *","li_req":"y","li_nm":"business-address-1"},{"lid":"1549395408432","ls":"110","loff":"","li_type":"in","li_name":"business-address-2","li_title":"Address 2","li_nm":"business-address-2"},{"lid":"1549395428943","ls":"120","loff":"","li_type":"in","li_name":"business-address-city","li_title":"City *","li_nm":"business-address-city"},{"lid":"1549395912647","ls":"130","loff":"","li_type":"sb","li_name":"business-address-state","li_title":"State *","li_req":"y","li_variants":"AK\nAL\nAR\nAZ\nCA\nCO\nCT\nDC\nDE\nFL\nGA\nHI\nIA\nID\nIL\nIN\nKS\nKY\nLA\nMA\nMD\nME\nMI\nMN\nMO\nMS\nMT\nNC\nND\nNE\nNH\nNJ\nNM\nNV\nNY\nOH\nOK\nOR\nPA\nRI\nSC\nSD\nTN\nTX\nUT\nVA\nVT\nWA\nWI\nWV\nWY\nAB\nBC\nMB\nNB\nNL\nNS\nNT\nNU\nON\nPE\nQC\nSK\nYT\nLB","li_nm":"business-address-state"},{"lid":"1549396884367","ls":"140","loff":"","li_type":"in","li_name":"business-address-zip","li_title":"Zip *","li_req":"y","li_nm":"business-address-zip"},{"lid":"1549396976193","ls":"150","loff":"","li_type":"tx","li_text":"<div style=\"font-size:22px;font-family:'OpinionPro';\" data-customstyle=\"yes\"><strong>Remit To Address<\/strong><\/div>"},{"lid":"1549397030721","ls":"160","loff":"","li_type":"in","li_name":"remit-address-1","li_title":"Address 1 *","li_req":"y","li_nm":"remit-address-1"},{"lid":"1549397065939","ls":"170","loff":"","li_type":"in","li_name":"remit-address-2","li_title":"Address 2","li_nm":"remit-address-2"},{"lid":"1549397095109","ls":"180","loff":"","li_type":"in","li_name":"remit-address-city","li_title":"City *","li_nm":"remit-address-city"},{"lid":"1549397132859","ls":"190","loff":"","li_type":"sb","li_name":"remit-address-state","li_title":"State *","li_req":"y","li_variants":"AK\nAL\nAR\nAZ\nCA\nCO\nCT\nDC\nDE\nFL\nGA\nHI\nIA\nID\nIL\nIN\nKS\nKY\nLA\nMA\nMD\nME\nMI\nMN\nMO\nMS\nMT\nNC\nND\nNE\nNH\nNJ\nNM\nNV\nNY\nOH\nOK\nOR\nPA\nRI\nSC\nSD\nTN\nTX\nUT\nVA\nVT\nWA\nWI\nWV\nWY\nAB\nBC\nMB\nNB\nNL\nNS\nNT\nNU\nON\nPE\nQC\nSK\nYT\nLB","li_nm":"remit-address-state"},{"lid":"1549397172729","ls":"200","loff":"","li_type":"in","li_name":"remit-address-zip","li_title":"Zip *","li_req":"y","li_nm":"remit-address-zip"},{"lid":"1549397421304","ls":"210","loff":"","li_type":"st","li_btntitle":"Next","li_btntitle2":"Back"},{"lid":"1549397404060","ls":"220","loff":"","li_type":"tx","li_text":"<div style=\"font-size:22px;font-family:'OpinionPro';\" data-customstyle=\"yes\"><strong>Insurance and Tax Information<\/strong><\/div>"},{"lid":"1549397540087","ls":"230","loff":"","li_type":"in","li_name":"insurance-company","li_title":" Insurance Company *","li_req":"y","li_nm":"insurance-company"},{"lid":"1549397592146","ls":"240","loff":"","li_type":"in","li_name":"insurance-agent-name","li_title":"Insurance Agent Name *","li_req":"y","li_nm":"insurance-agent-name"},{"lid":"1549397627101","ls":"250","loff":"","li_type":"in","li_name":"insurance-agent-email","li_title":"Insurance Agent Email","li_nm":"insurance-agent-email"},{"lid":"1549397671112","ls":"260","loff":"","li_type":"in","li_name":"insurance-agent-phone","li_title":"Insurance Agent Phone *","li_req":"y","li_nm":"insurance-agent-phone"},{"lid":"1549397647024","ls":"270","loff":"","li_type":"in","li_name":"insurance-agent-fax","li_title":"Insurance Agent Fax *","li_nm":"insurance-agent-fax"},{"lid":"1549397696167","ls":"280","loff":"","li_type":"in","li_name":"insurance-dot","li_title":"DOT Number *","li_req":"y","li_nm":"insurance-dot"},{"lid":"1549397720947","ls":"290","loff":"","li_type":"in","li_name":"insurance-mc","li_title":"MC Number *","li_req":"y","li_nm":"insurance-mc"},{"lid":"1549397737263","ls":"300","loff":"","li_type":"in","li_name":"insurance-icc-mc","li_title":"ICC MC Number","li_nm":"insurance-icc-mc"},{"lid":"1549397802716","ls":"310","loff":"","li_type":"in","li_name":"insurance-federal-tax-id","li_title":"Federal Tax ID *","li_req":"y","li_nm":"insurance-federal-tax-id"},{"lid":"1549398955034","ls":"320","loff":"","li_type":"st","li_btntitle":"Next","li_btntitle2":"Back"},{"lid":"1549398579712","ls":"330","loff":"","li_type":"tx","li_text":"<div style=\"font-size:22px;font-family:'OpinionPro';\" data-customstyle=\"yes\"><strong>Fleet Information<\/strong><\/div>"},{"lid":"1549397953520","ls":"340","loff":"","li_type":"rd","li_name":"fleet-states","li_title":" States\/Regions Serviced","li_variants":"Mid Atlantic (VA,WV,MD,DE,PA,NJ,DC)\nMid West (IL,IN,OH,MI,KY)\nNorth Central (KS,NE,SD,ND,WI,MN,IA,MO)\nNorth East (NY,CT,RI,MA,VT,NH,ME)\nNorth West (OR,WA,ID,MT,AK)\nSouth Central (TX,LA,OK,AR,MS)\nSouth East (TN,NC,SC,GA,AL,FL)\nSouth West (CA,NV,AZ,NM)\nRocky Mountains (UT,CO,WY)\nAK\nAL\nAR\nAZ\nCA\nCO\nCT\nDC\nDE\nFL\nGA\nHI\nIA\nID\nIL\nIN\nKS\nKY\nLA\nMA\nMD\nME\nMI\nMN\nMO\nMS\nMT\nNC\nND\nNE\nNH\nNJ\nNM\nNV\nNY\nOH\nOK\nOR\nPA\nRI\nSC\nSD\nTN\nTX\nUT\nVA\nVT\nWA\nWI\nWV\nWY\nAB\nBC\nMB\nNB\nNL\nNS\nNT\nNU\nON\nPE\nQC\nSK\nYT","li_radcb":"cb","li_nm":"fleet-states"},{"lid":"1549397494956","ls":"350","loff":"","li_type":"in","li_name":"fleet-trucks-in","li_title":"Trucks In Fleet *","li_req":"y","li_nm":"fleet-trucks-in"},{"lid":"1549400254708","ls":"360","loff":"","li_type":"in","li_name":"fleet-total-capacity","li_title":"Total Capacity *","li_req":"y","li_nm":"fleet-total-capacity"},{"lid":"1549400186884","ls":"370","loff":"","li_type":"in","li_title":"Trucks In Fleet *","li_req":"y","li_nm":"Trucks In Fleet "},{"lid":"1549400371596","ls":"380","loff":"","li_type":"cb","li_name":"fleet-inop-capable","li_label":"<div style=\"font-size:16px;\" data-customstyle=\"yes\">INOP Capable<\/div>","li_nm":"fleet-inop-capable"},{"lid":"1549400278843","ls":"390","loff":"","li_type":"cb","li_name":"fleet-have-winches","li_label":"<div style=\"font-size:16px;\" data-customstyle=\"yes\">Have Winches<\/div>","li_nm":"fleet-have-winches"},{"lid":"1549400677212","ls":"400","loff":"","li_type":"cb","li_name":"fleet-have-internet","li_label":"<div style=\"font-size:16px;\" data-customstyle=\"yes\">Trucks Have Internet<\/div>","li_nm":"fleet-have-internet"},{"lid":"1549400696985","ls":"410","loff":"","li_type":"cb","li_name":"fleet-have-straps","li_label":"<div style=\"font-size:16px;\" data-customstyle=\"yes\">Have Straps<\/div>","li_nm":"fleet-have-straps"},{"lid":"1549400713882","ls":"420","loff":"","li_type":"cb","li_name":"fleet-enclosed-trucks","li_label":"<div style=\"font-size:16px;\" data-customstyle=\"yes\">Enclosed Trucks<\/div>","li_nm":"fleet-enclosed-trucks"},{"lid":"1549400833635","ls":"430","loff":"","li_type":"cb","li_name":"fleet-twic-card","li_label":"<div style=\"font-size:16px;\" data-customstyle=\"yes\">TWIC Card<\/div>","li_nm":"fleet-twic-card"},{"lid":"1549400176294","ls":"440","loff":"","li_type":"tx","li_text":"<div style=\"font-size:22px;font-family:'OpinionPro';\" data-customstyle=\"yes\"><strong>Equipment Specifications<\/strong><\/div>"},{"lid":"1549471873715","ls":"450","loff":"","li_type":"tx","li_text":"<div style=\"font-size:18px;font-family:'OpinionPro';\" data-customstyle=\"yes\">Please specify the quantities of the open and enclosed trucks you have in your available inventory.<\/div>"},{"lid":"1549471896695","ls":"460","loff":"","li_type":"in","li_name":"equipment-spec-car1-quantity","li_title":"Car 1","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car1-quantity"},{"lid":"1549882812606","ls":"470","loff":"","li_type":"in","li_name":"equipment-spec-car2-quantity","li_title":"Car 2","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car2-quantity"},{"lid":"1549882829339","ls":"480","loff":"","li_type":"in","li_name":"equipment-spec-car3-quantity","li_title":"Car 3","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car3-quantity"},{"lid":"1549882849614","ls":"490","loff":"","li_type":"in","li_name":"equipment-spec-car4-quantity","li_title":"Car 4","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car4-quantity"},{"lid":"1549882837944","ls":"500","loff":"","li_type":"in","li_name":"equipment-spec-car5-quantity","li_title":"Car 5","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car5-quantity"},{"lid":"1549882865545","ls":"510","loff":"","li_type":"in","li_name":"equipment-spec-car6-quantity","li_title":"Car 6","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car6-quantity"},{"lid":"1549882875475","ls":"520","loff":"","li_type":"in","li_name":"equipment-spec-car7-quantity","li_title":"Car 7","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car7-quantity"},{"lid":"1549882884435","ls":"530","loff":"","li_type":"in","li_name":"equipment-spec-car8-quantity","li_title":"Car 8","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car8-quantity"},{"lid":"1549882891297","ls":"540","loff":"","li_type":"in","li_name":"equipment-spec-car9-quantity","li_title":"Car 9","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car9-quantity"},{"lid":"1549882899264","ls":"550","loff":"","li_type":"in","li_name":"equipment-spec-car10-quantity","li_title":"Car 10","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-car10-quantity"},{"lid":"1549882911573","ls":"560","loff":"","li_type":"in","li_name":"equipment-spec-flatbed-quantity","li_title":"Flatbed","li_subtitle":"Open or Enclosed Quantity","li_nm":"equipment-spec-flatbed-quantity"},{"lid":"1549397500849","ls":"570","loff":"","li_type":"tx","li_text":"<div style=\"font-size:22px;font-family:'OpinionPro';\" data-customstyle=\"yes\"><strong>Registration Paperwork<\/strong><\/div>"},{"lid":"1549472023767","ls":"580","loff":"","li_type":"tx","li_text":"<div style=\"font-size:14px;font-family:'OpinionPro';\" data-customstyle=\"yes\"> <strong><\/strong><strong><\/strong><strong>Download Documents<\/strong> <br><br> Please download, review, and complete the following registration documents as indicated. <strong>Notice:<\/strong> Files must be in PDF format in order for registration to be submitted. <br><\/div>"},{"lid":"1549472412242","ls":"590","loff":"","li_type":"tx","li_text":"<div style=\"font-size:14px;font-family:'OpinionPro';\" data-customstyle=\"yes\"><a href=\"https:\/\/ucarecdn.com\/e52ca271-87d2-430c-8008-c31c5e9cf6e9\/w92019.pdf\" style=\"\">w-9 2019.pdf<\/a><\/div>"},{"lid":"1549472333167","ls":"600","loff":"","li_type":"tx","li_text":"<div style=\"font-size:14px;font-family:'OpinionPro';\" data-customstyle=\"yes\"><a href=\"https:\/\/ucarecdn.com\/286b68d6-fae3-4626-8655-df817bedba2f\/ACHauthorizationformDessantTransportIncRev13019.pdf\" style=\"\">ACH authorization form Dessant Transport Inc Rev. 1.30.19.pdf<\/a><\/div>"},{"lid":"1549472361001","ls":"610","loff":"","li_type":"uc","li_title":"Attach New File","li_uckey":"ae2478fe42f43168a39b","li_nm":"Attach New File"}]
