Authority Application
Type of Authority
*
Please Select
Motor Common
Passengers
Broker (HHG)
Broker (EXCEPT HHG)
Freight Forwarder
Type of Business
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Sole Proprietor
Limited Liability Company (LLC)
Partnership
Corporation
Other
Legal Business Name
*
DBA
EIN#
*
(If you still need an EIN type (Need or None)
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Business Address (Physical)
*
City
*
State
*
Zip
*
Business Address (Mailing)
*
City
*
State
*
Zip
*
The Company is Owned/Controlled by :
US Citizen
Canadian Citizen
Mexico Citizen
Citizen of another Foreign Country
Owners, Officers, & Partners 1
Ownership
Full Name
*
First Name
Last Name
Title
*
Percentage of Ownership
*
SSN#
*
Date of Birth
*
Drivers License #
*
Owners, Officers, & Partners 2 (if Needed)
Ownership
Full Name
*
First Name
Last Name
Title
*
Percentage of Ownership
*
SSN#
*
Date of Birth
*
Drivers License #
*
Issuing State of DL
*
Limited Power of Attorney
The undersigned, does hereby designate and appoint Limited Power of Attorney to Hammer Lane Dispatch LLC or its partners to act as Attorney-in-Fact to prepare, sign and submit documents pertaining to obtaining financial products, offered by Hammer Lane Dispatch LLC. This Power of Attorney is canceled 90 days after the below date. Unless extended for dispatching purposes.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Additional Company Info
Needed info for Authority set up, Insurance Quotes, Factoring Quotes, Dispatching Quotes ect.
Number of Tractors
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Sleeper or Day Cab
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Sleeper
Day Cab
Other
Number of Trailers
*
Length of Trailers
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48ft
53ft
Other
Number of Box Trucks/Straight Trucks
*
Length or Box Truck/Straight Truck
*
Height of Box
*
Number of Hotshots (Pick up with Trailer)
*
CDL or Non CDL
*
Please Select
Yes
No
Length of Trailer
*
GVW (Truck, Trailer & Load)
*
Under 10,000 lbs
Over 10,000 lbs
Number of Vehicles Leased
*
Number of Vehicles Owned
*
Number of Drivers
*
With CDL
*
Without CDL
*
Affiliations
Please list MC/FF Number and USDOT Number of any FMCSA regulated entity that any owner has had ownership/management of in the last 3 years.
MC
USDOT
Company Names
Cargo Classification (Mark all that Apply)
*
General Freight
Metal (Sheets, Coils, Rolls)
Motor Vehicles
Drive-Tow Away
Logs, Poles, Beams, Lumber
Building Materials
Mobile Homes
Machinery, Large Objects
Fresh Produce
Liquid/Gas
Inermodal Cont.
Passengers
Oilfield Equipment
Livestock
Grain, Feed, Hay
Coal/Coke
Meat
Garbage/ Refuse
US Mail
Chemicals
Commodities Dry Bulk
Refrigerated Food
Beverages
Paper Products
Utilities
Agriculture/ Farm Supplies
Construction
Water Well
Other
Truck Info
Unit Number
Year
Make
Model
Title #
Purchase Date
Purchase Price
Plate #
Type a question
Lease
Own
Plate State/ Province
Unladen Weight
GVW (lbs)
NM Weight Distance #
(If Applicable)
NYHUT #
(If Applicable)
Color
Axles
VIN
Additional Information and Quote Requests
I would like additional Information on:
*
Factoring Quote (Get paid right away on loads)
Dispatching Quote (Get best load options)
Insurance Quote
Fuel Discounts
ELD Discounts
Roadside Assistance Discounts
Decals for Side of Truck Discounts
No Thanks
Safety Certification (for vehicle-operating applicants only)
If you will operate vehicles of more than 10,000 pounds GVWR and are, thus, subject to pertinent portions of the U.S. DOT’s Federal Motor Carrier Safety Regulations (FMCSRs) at 49 CFR, Chapter 3, Subchapter B (Parts 350-399), you must certify as follows:Applicant has access to and is familiar with all applicable U.S. DOT regulations relating to the safe operation of commercial vehicles and the safe transportation of hazardous materials and it will comply with these regulations. In so certifying, applicant is verifying that, at a minimum, it:Has in place a system and an individual responsible for ensuring overall compliance with FMCSRs;Can produce a copy of the FMCSRs and the Hazardous Materials Transportation Regulations;Has in place a driver safety training/orientation program;Has prepared and maintains an accident register (49 CFR Part 390.15);Is familiar with DOT regulations governing driver qualifications and has in place a system for overseeing driver qualification requirements (49 CFR Part 391);Has in place policies and procedures consistent with DOT regulations governing driving and operational safety of motor vehicles, including drivers’ hours of service and vehicle inspection, repair, and maintenance (49 CFR Parts 392, 395, and 396);Is familiar with and will have in place on the appropriate effective date, a system for complying with U.S. DOT regulations governing alcohol and controlled substances testing requirements (49 CFR Part 382 and 49 CFR Part 40).
I have received, read and agree to the Terms & Conditions for Hammer Lane Dispatch LLC, Treadstone US Capital, Limitless Business Solutions Power of Attorney of Hammer Lane Dispatch LLC and certify all the above statements to be true
*
Yes
Signature
*
Date
*
-
Month
-
Day
Year
Date
Terms and Conditions of Hammer Lane Dispatch, LLC and Affiliates
1. Proprietary Rights: All works of authorship, information, content, and material provided by Hammer Lane Dispatch LLC and Affiliates or appearing on or contained in their website (“Get Authority Now page on www.hammer-lanedispatch.com”) are the property of Hammer Lane Dispatch LLC and Affiliates. Information provided by Hammer Lane Dispatch LLC and Affiliates may be used solely for internal business purposes. Any reproduction, distribution or commercial use of any or all Get Authority Now page on www.hammer-lanedispatch.com, in whole or in part, without the prior written consent of Hammer Lane Dispatch, LLC is prohibited. All names, trademarks, service marks, symbols, slogans, and logos appearing on Get Authority Now page on www.hammer-lanedispatch.coms are proprietary to Hammer Lane Dispatch LLC. Use or misuse of these is expressly prohibited and may violate federal and state law. 2. Information Accuracy: You confirm information given, and entered onto the application and/or furnished on our website is, to the best of your knowledge is accurate, genuine, factual, legitimate and thorough . Furthermore, you certify that you are qualified, competent and authorized to file this application. 3. Indemnification or Changes: These Terms and Conditions may be revised at any time, with or without notice; you agree that we can make changes in our sole discretion, by Accepting these Terms and Conditions certifies your understanding, objective and agreement to be bound by such change. It is your sole responsibility to audit these Terms and Conditions for changes on our website at www.hammer-lanedispatch.com. You agree to defend, indemnify, and hold harmless Hammer Lane Dispatch LLC, its affiliates, its contractors, and all of their respective directors, officers, employees, representatives, proprietors, partners, shareholders, servants, principals, agents, predecessors, successors, assigns, accountants, and attorneys from and against any and all suits, actions, claims, proceedings, damages, settlements, judgments, injuries, liabilities, obligations, losses, risks, costs, and expenses (including without limitation attorneys’ fees and litigation expenses) relating to or arising from our services, our website, your use of our website, your fraud, violation of law, or willful misconduct, and any breach by you of these Terms and Conditions. 4. Internet Use: Use of the Internet is solely at your own risk and is subject to all applicable local, state, national, and international laws and regulations. Without limiting anything else in these Terms and Conditions or otherwise, neither Hammer Lane Dispatch, nor its contractors will be liable for any loss resulting from failure of electronic or mechanical equipment or communication lines, telephone or other interconnect problems, computer viruses, unauthorized access, theft, operator errors, severe weather, earthquakes, natural disasters, strikes or other labor problems, wars, or governmental restrictions. 5. Information Use: You hereby authorize Hammer Lane Dispatch LLC the right to use in connection with the provision, maintenance, operation, and administration of our services, whether in conjunction with information provided by Hammer Lane Dispatch LLC its affiliates, its contractors, and all of their respective directors, officers, employees, representatives, proprietors, partners, shareholders, servants, principals, agents, predecessors, successors, assigns, accountants, and attorneys, and in whatever form or format Hammer Lane Dispatch LLC chooses, the information you provide to Hammer Lane Dispatch LLC, whether directly online or other means necessary for service. You warrant the information provided is accurate, honest and complete. 6. Relationship: You agree that Hammer Lane Dispatch LLC and you are independent contractors. No partnership, joint venture, agency, employer/employee, franchisor/franchisee, or any other relationship exists or is created by our Applications or your use of our website and or Hammer Lane Dispatch LLC's services secured by you with respect to forgo on your behalf. 7. Disclaimers, Warranties or Liabilities: THE GET AUTHORITY NOW PAGE ON WWW.HAMMER-LANEDISPATCH.COM, INCLUDING THOSE ON,IN AND CREATED AVAILABLE THROUGH OUR WEBSITE, OUR SERVICES, OUR INFORMATION, AND OUR PRODUCTS OFFERED IN CONCLUSION THEREWITH ARE MADE AVAILABLE “AS IS” AND “WITH ALL FAULTS.” HAMMER LANE DISPATCH LLC MAKES NO REPRESENTATIONS OR WARRANTIES, AND DISCLAIMS ALL REPRESENTATIONS AND WARRANTIES, WITH RESPECT TO THE GET AUTHORITY NOW PAGE ON WWW.HAMMER-LANEDISPATCH.COM, INCLUDING THOSE ON AND IN AND MADE AVAILABLE THROUGH OUR WEBSITE, AND THE SERVICES, INFORMATION, AND PRODUCTS OFFERED IN CONNECTION THEREWITH, EXPRESS OR IMPLIED, WRITTEN OR ORAL, ARISING FROM COURSE OF DEALING, COURSE OF PERFORMANCE, USAGE OF TRADE, OR OTHERWISE, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, ACCURACY, SYSTEMS INTEGRATION, NON-INTERFERENCE, QUALITY, TITLE, AND NON-INFRINGEMENT. THE ENTIRE RISK AS TO SATISFACTORY QUALITY, PERFORMANCE, ACCURACY, AND EFFORT WITH REGARD TO ANY AND ALL GET AUTHORITY NOW PAGE ON WWW.HAMMER-LANEDISPATCH.COM IS WITH YOU. HAMMER LANE DISPATCH LLC SHALL NOT BE LIABLE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY, EXTRA-CONTRACTUAL, OR PUNITIVE DAMAGES OF ANY KIND WHATEVER, INCLUDING, WITHOUT LIMITATION, LOST REVENUES OR LOST PROFITS, WHICH MAY OR DOES RESULT FROM THE USE OF, ACCESS TO, OR INABILITY TO USE WWW.HAMMER-LANEDISPATCH.COM, INCLUDING THOSE ON AND IN AND MADE AVAILABLE THROUGH OUR WEBSITE, OR THE SERVICES, INFORMATION, AND PRODUCTS OFFERED IN CONNECTION THEREWITH, REGARDLESS OF LEGAL THEORY, WHETHER OR NOT ANY PARTY HAD BEEN ADVISED OF THE POSSIBILITY OR PROBABILITY OF SUCH DAMAGES, AND EVEN IF THE REMEDIES OTHERWISE AVAILABLE FAIL OF THEIR ESSENTIAL PURPOSE. UNDER NO CIRCUMSTANCES WILL THE TOTAL LIABILITY OF HAMMER LANE DISPATCH LLC TO YOU OR ANY OTHER PERSON OR PERSONS IN CONNECTION WITH GET AUTHORITY NOW PAGE ON WWW.HAMMER-LANEDISPATCH.COM, INCLUDING THOSE ON AND IN AND MADE AVAILABLE THROUGH OUR WEBSITE, OR THE SERVICES, INFORMATION, OR PRODUCTS OFFERED IN CONNECTION THEREWITH EXCEED THE LESSOR OF A) THE AMOUNT OF FEES YOU PAY TO US IN ANY ONE MONTH, OR B) $100.6. 8. Governing Law and Jurisdiction: These Terms and Conditions will be governed by and construed in accordance with the laws of the State of Oregon, without reference to its conflict of law rules; PROVIDED, HOWEVER, THAT THE TERMS OF ANY APPLICABLE LAW NOW OR HEREAFTER ENACTED THAT IS BASED ON, DERIVED FROM, SIMILAR TO, OR CONNECTED WITH THE UNIFORM COMPUTER INFORMATION TRANSACTIONS ACT DRAFTED BY THE NATIONAL CONFERENCE OF COMMISSIONERS ON UNIFORM STATE LAWS SHALL NOT APPLY EXCEPT TO THE EXTENT THAT THE LAW EXPRESSLY PROHIBITS ALTERATION BY THESE TERMS AND CONDITIONS OF THE APPLICABILITY OF ONE OR MORE SECTIONS OF THE LAW. 10. Miscellaneous: Accessing, viewing, or using the works, content, or materials on this www.hammer-lanedispatch.com, you consent to the exclusive jurisdiction of the federal and state courts presiding in Jackson County, Oregon, and agree to accept service of process by personal delivery or mail and hereby waive any and all jurisdictional and venue defenses otherwise available. Our website is managed, regulated and operated by Hammer Lane Dispatch LLC from its offices within the United States. Hammer Lane Dispatch LLC makes no representation that the works, content, materials, services, information, or products available on, in, or through our website are appropriate or available for use in other locations, and access to them from territories where they are illegal is prohibited. Those who access our website from alternate locations do so at their own discretion and are held solely responsible for compliance with applicable laws. The waiver or failure of Hammer Lane Dispatch LLC to exercise in any respect any right provided hereunder shall not be deemed a waiver of such right in the future or a waiver of any of other rights established under these Terms and Conditions. Headings used in these Terms and Conditions are for reference only and shall not affect the interpretation of these
Factoring Terms and Conditions
Terms and Conditions. Hammer Lane Dispatch LLC reserves all rights to terminate its services to you in the event that you violate these Terms and Conditions or for any reason whatever or no reason, with or without notice, in addition to any and all other remedies available at law or in equity. I/We have been disclosed and do understand that the submission of an application for Factoring Services with Treadstone US Capital ("Treadstone") does not mean that Treadstone will provide any factoring services whatsoever. I/We further do understand that approval may come only after the management of Treadstone approves said application and agreement for the factoring services offered are approved in accordance with the terms of Treadstone's Agreement with said Client. The information supplied in this Application and all forms and documents submitted to Hammer Lane Dispatch and/ or Treadstone in connection herewith are true and correct to the best of my/our knowledge and belief. I/We understand that I/We may be responsible for all basic costs associated with processing this application. In support of this Application, Treadstone and or Hammer Lane Dispatch LLC is hereby authorized to obtain personal and business credit and/or financial information from my/our bank(s), insurance company, accountant, and other financial institutions or commercial firms with whom I/We have done business as well as credit reporting agencies. It is understood that any such credit and/or financial information will be held in strict confidence and used only in consideration of this Application. As inducement for Treadstone or Hammer Lane Dispatch LLC to process this application, Applicant grants to Treadstone or a security interest in their accounts receivables.
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