Information Request Form

DISPATCHER SERVICE AGREEMENT
Whereas, Carrier is a MOTOR CONTRACT CARRIER, desiring to retain Checkpoint Dispatching and Logistics LLC by executing a Limited Power of Attorney to secure freight and dispatcher services as well as signing rate confirmations and submitting invoices on the behalf of THE CARRIER.

Whereas, Checkpoint Dispatching and Logistics LLC is a freight and transportation dispatching service provider handling the necessary paperwork between shippers/brokers and THE CARRIER. Also booking and negotiating rates on behalf of the THE CARRIER.

The CARRIER must prior to the implementation of this service agreement furnish the following to Checkpoint Dispatching and Logistics LLC:

• Copy of CDL

• Copy of MC Authority

• Copy of DOT #

• Certificate of Insurance ($1,000,000 Liability And $100,000 Cargo)

• EIN Number or SSN

• W-9

• Copies Of Owner and All Driver CDL-A

• NOA from Factoring Company and Representative Contact Information

Alternately, the documents above can be emailed to support@checkpointdispatch.com
CARRIER/Trucking Company Information and Equipment
Carrier / Company Names

Street Address Line 2

CityState / Province

Postal / Zip Code
Carrier Owner

Street Address Line 2

CityState / Province

Postal / Zip Code
Motor Carrier # (MC)

Street Address Line 2

CityState / Province

Postal / Zip Code
DOT #

Street Address Line 2

CityState / Province

Postal / Zip Code
License Plate #1

Street Address Line 2

CityState / Province

Postal / Zip Code
Truck #1

Street Address Line 2

CityState / Province

Postal / Zip Code
Trailer #1

Street Address Line 2

CityState / Province

Postal / Zip Code
License Plate #2

Street Address Line 2

CityState / Province

Postal / Zip Code
Truck #2

Street Address Line 2

CityState / Province

Postal / Zip Code
Trailer #2

Street Address Line 2

CityState / Province

Postal / Zip Code
License Plate #3

Street Address Line 2

CityState / Province

Postal / Zip Code
Truck #3

Street Address Line 2

CityState / Province

Postal / Zip Code
Trailer #3

Street Address Line 2

CityState / Province

Postal / Zip Code
License Plate #4

Street Address Line 2

CityState / Province

Postal / Zip Code
Truck #4

Street Address Line 2

CityState / Province

Postal / Zip Code
Trailer #4

Street Address Line 2

CityState / Province

Postal / Zip Code
hereby grants authorization or permission to: Checkpoint Dispatching and Logistics LLC to act as Load Dispatcher/Logistics Manager for the sole purpose of searching for and booking loads, processing brokerage paperwork and obtaining and/or submitting necessary documents required in order to expedite and dispatch loads via telephone, fax or email for the Carrier.
ALL BILLING, INVOICING, AND COLLECTIONS OF REVENUE FROM SHIPPERS, BROKERS AND/OR FACTORING COMPANIES ARE THE SOLE RESPONSIBILITY OF THE CARRIER/TRUCKING COMPANY, UNLESS Checkpoint Dispatching and Logistics LLC AND CARRIER/TRUCKING COMPANY HAVE ARRANGED AND AGREED UPON ADDITIONAL SERVICES PROVIDED TO THE CARRIER/TRUCKING COMPANY BY Checkpoint Dispatching and Logistics LLC. If revenue for a shipment or shipments is uncollectible, Checkpoint Dispatching and Logistics LLC will be held harmless and no penalty or deduction of fees will be made.

CARRIER/Trucking Company agrees that it will not solicit traffic from any shipper, consignor, or customer of Checkpoint Dispatching and Logistics LLC where the CARRIER transports loads, or is made aware of such traffic, as a result of Checkpoint Dispatching and Logistics LLC's efforts. It is further agreed that this non-solicitation provision shall remain in effect during the term of this AGREEMENT and for a period of one (1) year from the date of the termination of this SERVICE AGREEMENT for any reason. In the event of non-compliance with the specific provisions of this paragraph, CARRIER upon discovery of breach, be liable to Checkpoint Dispatching and Logistics LLC for 100 percent (100%) of the gross transportation revenue received by CARRIER from said shipper(s) within one (1) year after the date of termination of this AGREEMENT.

The CARRIER/Trucking Company agrees to maintain all proper licenses and permits (UCR, IFTA, IRP, etc.) to conduct business as a motor carrier in the area of intended operation, either Intrastate or Interstate.

The CARRIER/Trucking Company agrees to maintain general liability ($1 million) and cargo insurance ($100,000) at the amounts set forth by the home state of the Carrier / Trucking company. Checkpoint Dispatching and Logistics LLC will be held harmless in the event of any and all claims.

To begin service Checkpoint Dispatching and Logistics LLC will bill the CARRIER/Trucking Company a refundable security deposit of $400. The $400 security deposit must be paid for services to begin. The $400 deposit is reserved to cover unpaid invoices in the event of termination of the service contract. In the event that the service contract is canceled, and the CARRIER/Trucking Company owes a balance. The security deposit will be applied toward any outstanding balance due to Checkpoint Dispatching and Logistics LLC. If no outstanding balance is owed upon termination of this contract, the security deposit will be refunded to the CARRIER/Trucking Company.

The Fee for Dispatching Services SHALL be 10% As Loads/Freight/Cargo are picked up, delivered, and the Carrier/Trucking Company is paid FIRST, an amount equal to the above stated percentage/pricing scheme will be billed and payable weekly to: Checkpoint Dispatching and Logistics LLC. Each Invoice will be sent by Monday for the previous week of service. Payment is due Tuesday by 6PM EST. Invoices paid after Tuesday will incur a $150 late fee. Failure to pay the current invoice within FIVE (5) days of invoicing will result in a termination of the contract at the discretion of Checkpoint Dispatching and Logistics LLC.

Checkpoint Dispatching and Logistics LLC reserves the right to discontinue booking loads and terminate the contract due to unpaid invoices. Either party has the right to end this service agreement without cause at any time with seven (7) days notice by written request. By signing below, I fully understand the terms of this agreement.
Carrier Signatory Section
Carrier Name
Motor Carrier # (MC)
DOT #
Carrier Owner Name
Date

MonthDayYear
Date
Primary Phone Number
Please enter a valid phone number.
Primary Email
example@example.com
Carrier Owner Signature

Clear
Carrier Company Name
hereby appoints Checkpoint Dispatching and Logistics LLC at 40315 Michigan Ave. #1114, Canton, MI 48188, as the attorney-in-fact, to receive on my behalf information from Direct Shippers and Property Brokers, to obtain loads and to sign freight rate confirmations on my behalf pertaining to such information.

This limited power of attorney will expire in twelve months from the signed date above. By default, death, incapacitation, or signing a Revocation Form can cancel a power of attorney designation.

The affiant being duly sworn affirms and says that he or she is the signer(s) of the foregoing power of attorney, and that he or she has read the foregoing power of attorney and understands.
Dispatcher Signatory Section
Company Name

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Owner

Street Address Line 2

CityState / Province

Postal / Zip Code
Date

MonthDayYear
Date
Primary Phone Number
Primary Email
Owner Signature

Clear
Should be Empty:

DISPATCHER SERVICE AGREEMENT

CARRIER/Trucking Company Information and Equipment

Carrier Signatory Section

Dispatcher Signatory Section