Owner Operator Lease Application

Please complete all sections of this application thoroughly. All fields marked with * are required. Your application will be emailed to our team for review.

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

Social Security Number *

Street Address *

City *

State *

ZIP Code *

CDL & Medical Information

CDL Number *

CDL State *

CDL Class *

CDL Expiration Date *

Medical Certificate Expiration *

Years of Driving Experience *

Driver's License Upload *

Click to upload driver's license

Medical Certificate Upload *

Click to upload medical certificate

Business Information

Business Name (if applicable)

EIN (if applicable)

Previous Carriers (Last 3 years)

Equipment Information

Equipment #1

Equipment Type *

Year *

Make *

Model *

VIN *

License Plate *

Plate State *

Insurance Carrier *

Policy Number *

Insurance Document Upload

Click to upload insurance certificate

Vehicle Registration Upload

Click to upload registration

Additional Drivers

Add any additional drivers who will operate your equipment

No additional drivers added. Click "Add Driver" if you have additional drivers.

Emergency Contact

Name *

Phone Number *

Relationship *

Safety & Background Information

Have you had any accidents in the last 3 years? *

NoYes

Have you had any moving violations in the last 3 years? *

NoYes

Additional Information

By submitting this application, I certify that all information provided is true and accurate. I authorize LoadX Logistics to verify my employment history, driving record, and conduct background checks as necessary.