Independent Contractor Sheet

We are an equal opportunity employer, dedicated to a policy of non-discrimination on any basis including sex, race, color, religion, national origin, age, disability, orother characteristics protected under applicable law.

* Contractor Name:
Address:
City:
State:
Zip:
Phone Number:
Cellular Phone:
Fax Number:
* Email:
* Vehicle Make:
* Vehicle Model:
* Vehicle Year:
* Vehicle Capacity:
Area you are interested in running routes:
* City:
* State:
If you would like to attach your resume, please do so:

Minimum Limits of Auto Insurance Coverage Required:
(1) $100,000 for bodily injury to, or death of one person;
i. $300,000 for bodily injury to, or death of, all persons injured or killed in any one accident, subject to a minimum of $100,000 per person;
ii. $50,000 for loss or damage to property of others in one accident, excluding cargo.