Consultation Profile Questionnaire Please complete as accurately and as fully as you can. First Name Last Name Job Title Company Name* Address Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Website Address Email* What is a good business contact number?* Cell Phone Fax Have you had experience as a carrier, broker or freight forwarder?*YesNo If yes, how long? Do you have a BMC-84 or BMC-85?*BMC-84BMC-85I do not have either What part of industry will you service? Auto TransporterFreight BrokerCarrierFreight Forwarder What is your method of funding to pay carriers? Solvent at own expenseFactoring Invoices What area do you require training? Do you have additional personnel that require training?YesNo How many personnel in your company? On a scale of 1-10 (with 1 = None and 10 = Extremely Experienced) what would you rate your level of expertise in reaching shippers?0010 Is your business home based or commercially zoned?Home BasedCommerically Zoned Do you know the services required to be in compliance of FMCSA, and prepared to meet those requirements? Today's broker minimum requirements are? Do you know the services required to be in compliance of FMCSA, and prepared to meet those requirements? Carrier requirement for over the road requirements is? Do you have Sole Proprietorship, Corporation, Partnership or LLCSole ProprietorshipCorporationPartnershipLLC Do you have an EIN or TIN if so please provide or send a copy of your W-9? I have a TINI have an EINI use my SSN Do you have a Duns & Bradstreet number if so please provide? FOR ALL MOTOR CARRIERS AND FREIGHT FORWARDERS PLEASE PROVIDE EXPECTED NUMBER OF ASSETS (trucks, trailers with trailer types such as VAN, REEFER, FLATBED, STEP DECK, TANKER, OTHER Etc.! PLEASE PROVIDE A Certificate of Organization for a Corporations and or LLC! PLEASE SUBMIT Tax PaperworkSubmitReset Please feel free to contact Willis Transportation with any and all questions and concerns by email at email@example.com or firstname.lastname@example.org. You can also contact us by using the form below.