AGENT REQUEST FORM Name* Email* Phone Applying for* ---Independent Freight AgentCommission Sales Agent Where are you located? Who are you currently an agent for? Agent experience* ---YesNo How many years? Affiliated with? Sales experience How many years? Do you currently have an active client base of direct customers? ---YesNo Freight moved* TLTLTLFLATBEDSPECIALTY EQUIPMENTDRYTEMPHAZEXPEDITED How many shipments per day do you control or manage?* What is your current monthly gross revenue?* What is your average profit?* Why are you interested in joining the Pinnacle Freight Systems team? What can we do to make you successful in this new business venture? Could you refer someone else? Please provide their name and contact information.