Contact Name: *

First Name

Last Name

Phone: *

(###)

###

####

Do you meet the below requirements to contract with AD United?

*I have been in business as a carrier for at least 3 months. *I have a cargo insurance with coverage of at least $100,000. *I have an auto insurance with coverage of at least $1,000,000.

Yes

No

What best describes you?

Owner operator

Owner

Dispatcher

Driver