DSTRILOGIX manages 5 data types including driver carrier assignments. Helps you organize, track, and share your work in 1 place for teams and solo users.

Broker Account Application

Used to collect broker company profiles, verification documents, and portal-access preferences for account establishment and load visibility eligibility.

Full Name*

Phone Number*

Email Address*

Broker Company

Legal Company Name*

DBA

Authorized Contact Name*

Title

Email*

Phone*

Physical Address*

City*

State*

ZIP*

EIN - Restricted*

Broker MC Number*

USDOT Number if applicable

Authority, Bond, and Credit

Authority Status*

Authority Effective Date*

Bond / Trust Provider*

Bond / Trust Number*

Effective Date*

Expiration Date*

W-9*

Broker Authority Record*

Bond / Trust Evidence*

Broker-Carrier Agreement if applicable

Credit Reference 1

Credit Reference 1 Contact

Credit Reference 1 Phone / Email

Credit Reference 2

Credit Reference 2 Contact

Credit Reference 2 Phone / Email

Portal Visibility Preferences

Allow assigned-load status updates?*

Yes

Allow GPS map visibility for assigned loads?*

Yes

Allow approved driver photos/documents for assigned loads?*

Yes

Certification

Authorized Representative*

Signature*

By typing your name, you are electronically signing this document.

Date*