First/Last Name:  
Address:  
   
City/State/Zip:  
Phone #:   Ex: 123-123-1234
Email Address:  
Verify Email Address:  
Company Name (if incorporated):  

1. Do you have any home delivery experience?   Yes No
   a. If yes, provide some detail:
2. Are you already in business?   Yes No
   a. If no are you capable to start a business?   Yes No
3. Do you currently own a truck?   Yes No  (If yes skip to c.)
   a. If no, are capable of buying or leasing a truck?   Yes No
   b. If no, would you be interested in renting one from us?   Yes No
   c. If yes, provide Year, Make, Model, and size.  (Year)
   (Make)
   (Model)
   (Size)
4. Do you currently have helpers/employees?   Yes No
   a. If no, are you capable of hiring helpers/employees?   Yes No
5. Do you have a clean driving record?   Yes No
6. Do you have any felonies?   Yes No
   a. If yes, please list them.
7. Are you currently delivering or contracting for anyone?   Yes No
Additional Comments:
 
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RDI LOGISTICS, INC.  Your Dedicated Logistics Specialist
8 Norfolk Avenue  *  South Easton, MA 02375
Toll Free:  877-RDI-TRUCK  *  Phone: 508-205-0530   *  Fax: 508-205-0538