1. Please provide the following contact information: (*Required Field)

   *First Name
   *Last Name
   Title
   Organization
   Street Address
   Address (cont.)
   *City
   State/Province
   Zip/Postal Code
   *Work Phone
   *Home Phone
   FAX
   *E-mail

2. How would you like correspondence sent?

   By fax number provided
   By Email 
   
   

3. How did you hear about Interstate Transport?

   Trade Paper
   Newspaper
   Internet Ad
   Search Engine
   Friend
   Other
   

4. Do you have experience working as a Customer/Carrier Sales Representative?

   Yes No
   

5. If yes, for how long? (months)

   
   

6. Are you currently working as a Customer/Carrier Sales Representative?

   Yes No
   

7. If yes, for how long? (months)

   
   

8. Do you have an established customer base?

   Yes No
   

9. If yes, how many? ( enter 0 for none )

   
   

10. Do you have a reliable carrier following?

    Yes No
    

11. How many loads on average, do you currently book per week? (enter 0 for none)

    
    

12. Please provide examples of the type of product (s) you currently handle for your customers.

     
    

13. What is the average amount billed to your client for each load?

    
    

14. What is the average length of haul for each load?

    
    

15. What was your gross revenue billed to customers in 2006?

    
    

16. What was your gross PROFIT generated from loads in 2006 (not just your commission, but the total gross profit)?

    
    

17. If you're an agent now, what percentage do you keep of the gross profit?

    
    

18. Can you move to Saint Petersburg, Florida?

    Yes No
    

19. Additional comments or qualifications.

20. Where did you hear about the Customer/Carrier Sales Representative position?

To the best of my knowledge the information provided is accurate. I understand that prior to an offer being made I will be required to provide information to verify my qualifications.

It is recommended that you also send your resume to jobs@interstate-transport.com

After you have submitted your information we will review the details and contact you within one business day. Thank you for requesting more information.