Long Haul Application Form

Welcome to the Gallop team of long haul carriers. Before we get you loaded, it is mandatory that you to fill out this background information sheet for us.

Here's some payment information that you need to know when you're working with Gallop:

• There is no charge when you receive payment by cheque.
• On every Comcheck there's a $10 charge.
• If you don't take an advance on a To The Truck Rate, there's no charge.
• If you take an advance on a To The Truck Rate, there's a 2% brokerage fee of the gross.
• On all regular rates there's an 8% brokerage fee, if you take an advance it goes up to 10%.

When you're empty all you have to do to get paid in 24 hours is fax your BOLs to Dinah at 416-252-2670. Do not call for inquiries regarding payment but email us at payables@galloplogistics.com or fax us at 416-252-2670. Be sure that the BOLs are legible, have the load # and how you would like to get paid (cheque or ComCheck) written on them so that your payment is processed in 24 hours.

Name:
Email Address:
Company:
# of Reefers:
Business Phone #:
After-Hours Phone #:
Cell #:
Lanes:
MC #:
Fax #:
Years In Business:
Insurance Information
Please note - if you are interested in hauling produce, you will need to have refrigeration breakdown coverage under your cargo policy
Insurance Broker Name:
Insurance Broker Phone #:
Insurance Broker Fax #:
Cargo Policy #:
References
Reference #1 (a company that you have done business with, not your own or a family member)
Company Name:
Contact:
Phone Number:
# Of Years Doing Business With Them:
# Of Loads Done With Them:
Reference #2 (a company that you have done business with, not your own or a family member)
Company Name:
Contact:
Phone Number:
# Of Years Doing Business With Them:
# Of Loads Done With Them:
Reference #3 (a company that you have done business with, not your own or a family member)
Company Name:
Contact:
Phone Number:
# Of Years Doing Business With Them:
# Of Loads Done With Them: