Owner Operator Application – NYB Ventures Group Inc

Congratulations your only moments away from partnering with an amazing company that focuses on assisting you grow and expand your business. We are committed to excellence in everything we do and have no doubt that you will be happy within our company.

To complete the onboarding process please ensure you answer all questions honest and thoroughly.

DO NOT COMPLETE THIS APPLICATION IF YOU HAVE YOUR OWN AUTHORITY

First Name *

Last Name *

Date Of Birth *

Social Security *

Phone Number *

License Number *

License State *

Email *

Address *

City

State *

Zip

Have you lived here less than 3 years?

Please Provide Your Previous Address *

Do you have a class A CDL?

How long have you held a CDL?

Is your CDL older than 2yrs? *

Upload a picture of your CDL

Maximum upload size: 20.97MB

Do you have your own authority? *

What type of equipment do you have? *

Other

Please give the following info for all equipment

If your applying for lease purchase then this does not apply to you put N/A in the boxes below

MAKE *

MODEL *

VIN *

Add Equipment Remove Equipment

How many of each equipment do you own?

Value of each piece of equipment

Upload your insurance card

Maximum upload size: 20.97MB

Location

City

State *

Any Service Restrictions location wise? *

If you selected YES please describe restrictions in the box below

Do you have an ELD? *

DRIVER INFORMATION

Are you the driver? *

Yes

No

Please give us some info on your driver(s)

NAME *

CDL TYPE

ISSUSE DATE

Add New Driver Remove Driver

Please upload your registration

Maximum upload size: 20.97MB

Upload a picture of your MVR

Maximum upload size: 20.97MB

Have you had any moving violations in the past 3 years?

How many days are you willing to be on the road? *

Do you have a clearing house?

If you answered "YES" what company do you use?

Do you have physical damage insurance?

Do you have bob tail insurance?

Upload your bob tail insurance

Maximum upload size: 20.97MB

Bank Account Number

Bank Routing Number

Bank Name and Address

AGREEMENT

To Be Read and Signed by Applicant

Client agrees to indemnify, defend and hold harmless NYB Ventures Group INC and it's officers, employees, affiliates and agents from and against any and all losses, liabilities, claims or damages asserted by third parties arising out of or in connection with NYB Ventures Group INC performance of its obligations under the Agreement, except to the extent that such losses, liabilities, claims or damages are judicially determined to have resulted directly and primarily from the willful misconduct or gross negligence of NYB Ventures Group Inc. Client agrees to strict no refund policy. Client further agrees to indemnify, defend and hold harmless NYB Ventures Group Inc and its officers, employees affiliates and agents from and against any and all losses, liabilities, claims or damage asserted by third parties arising out of or in connection with any and all misrepresentations or false or misleading information made to any party, including Consulting, by Client or any of its officers, employees, affiliates or agents.

I Agree *

I Agree

Signature *

Clear

Date *