H and W Trucking, Inc. NEW AGENT QUESTIONNAIRE

Name: _____________________________________________________________________

Address:_____________________________City:________________________ State:_____ Zip:___________

Phone: (____) _____________Fax (____)________________ Email: _________________________

What were your annual sales for: 2008_____________2007______________2006_______________?

What were your profit margins for each year? 08________ 07_____________ 06

Current employer? ___________________________________________________________

How long have you been there?___________

Reasons for making a change____________________________________________________________

Have you signed a non-compete contract? __________

Primary lanes served? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What commodities do you move? ___________________________________________________

What agent services do you provide? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What % of your loads are:

Truckload______ LTL_____airfreight_____rail/intermodal_____ocean____warehousing_____

What equipment do you use? Dry van______ refrigerated_______ flatbed________

Current compensation _______________Preferred compensation________________

Other considerations_____________________________________________________________

Please email back to barcy@handwtrucking.com or fax to 740-345-0146