Driver / Courier Application Form

First Name *

Last Name *

Email *

Phone *

City *

State *

Are you over the age of 21? *

Do you own or lease a vehicle? *

What type of vehicle do you drive? *

Cargo Van

Car

SUV

Mini Van

What make is your vehicle? *

What model is your vehicle? *

What year is your vehicle? *

Is your phone less than 5 years old? *

Are you able to carry at least 50 pounds? *

What time of day are you available to provide service? *

Mornings

Afternoons

Evenings

Overnight

Are you a United states Citizen? *

Do you have a valid driver's license? *

Did you receive your first driver's license within the last 12 months? *

Do you have an active automobile insurance policy? *

If yes, are you listed as a driver on the policy?

Have you ever been "CONVICTED" of driving under the influence (DUI) ? *

In the last 5 years, have you received any moving violations? *

If yes please state the nature of the moving violation and the date of the violation:

Some Red Fox customers require to be drug tested in order to perform delivery services. Would you be willing to submit a drug test to make deliveries for these customers? *

Why are you interested in becoming a driver for Red Fox? *

When are you available to start? *

By checking this box, I consent to receive automated reminders and service-related messages from Red Fox Medical Courier at the phone number and/or email I provided above. These may include appointment reminders, order confirmations, account notifications, and similar messages. Message and data rates may apply. Frequency may vary. Reply HELP for assistance or STOP to opt‑out at any time.

I confirm that I have read and agree to the Privacy Policy and Terms of Service.