Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Order # *OriginCity *State *—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPickup Date *DestinationCity *State *—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDelivery Date *CompanyCompany Name *DOT # *Dispatcher Full Name *Phone *FaxEmail *DriverDriver Full Name *Phone *Email *Reload CheckboxI am interested in reload options.You must agree to the following Subcontractor Agreement before your load will be dispatched to you. Terms Driver must complete a condition report and bill of landing for each vehicle. The bill of lading and condition report must both be signed by the customers and have the customer printed name for payment. Accelerated Services, LLC must be contacted immediately by a representative of your company if a vehicle will not load or drop on the dates specified above. Failure to notify Accelerated Services, LLC of a cancelled order will result in a 10% charge. Driver must contact pickup party as soon as possible to coordinate pickup. Driver must contact delivery part as soon as possible to coordinate delivery. A copy of the delivery signed receipt must be faxed to our office within 24 hours of drop off by the driver or your office. PRICE INFORMATION MUST NOT BE SHARED WITH CUSTOMERS. Driver must verify all vehicle information. If there are any discrepancies, call our office immediately. Do not pick up unauthorized vehicles. Do not broker or reassign load. A 20% penalty may be charged to your company if these conditions are not met. I understand and agree the driver must use the Magnus App for all pickup and delivery information Acknowledgement Checkbox *I understand and agree to all of the above terms.Digital Signature * Clear Signature Submit