Carrier Profile Form

Carrier Profile Form

Company and Driver Agreement
Thank you for having us a trusted partner for your trucking company. We strive to keep your truck loaded and rolling.
CARRIER NAME
DATE OF AGREEMENT

MonthDayYear
Date
This Agreement is made the Date of Agreement form was submitted, between PICTUREJASS LLC and Type a label (MC Type a label) which address is Type a label, collectively referred to as (CLIENT or CARRIER) as follows:
1. CLIENT’S General Duties. CLIENT in a good manner will deliver consumer items and freight cargo items for brokers and customers and perform such other transportation and related services as may be necessary to serve customers. Ensure safety and compliance during operation.
2. COMPANY’S General Duties. COMPANY will assist with all aspects of freight booking process for a CLIENT. COMPANY will act as CLIENT’S non-exclusive representative when dealing with Brokers and complete any necessary documentation on behalf of CLIENT as outlined in Exhibit A.
3. Duration. This Agreement shall become effective on the date inserted in the first sentence of this agreement. Thereafter, it shall be effective from month to month unless sooner terminated in accordance with paragraph 4.
4. Termination. This Agreement may be terminated at any time: (a) by mutual consent; (b) by the insolvency of CLIENT due to non-payment as outlined in Exhibit B; (c) without cause upon either party giving the other (1 ) days written notice of termination; or (d) with cause upon the breach of this agreement by either of the parties.
5. Payment. CLIENT shall pay COMPANY x amount for services provided as outlined in Exhibit B.
6. Equipment. CLIENT will provide its own equipment.
7. Insurance. CLIENT will carry at its own expense physical damage, bobtail, cargo and liability insurance upon any vehicles or other equipment used by it in carrying out its duties under this agreement.
8. Labor and Hold Harmless. CLIENT shall, at its own expense: (a)furnish whatever labor is necessary to provide delivery services to BROKERS AND SHIPPERS, and (b) provide Worker’s Compensation and Employer’s Liability Insurance if necessary. CLIENT shall also be responsible for payment of wages and social security and withholding taxes for any of its employees. CLIENT shall hold COMPANY harmless from any liability resulting from injury or death of any persons including but not limited to driving, operating, repairing, maintaining, loading or unloading CLIENT’S equipment.
9. Safety and Compliance CLIENT is fully responsible and liable for safety and compliance of the operation. CLIENT shall hold COMPANY harmless from any liability resulting from safety and compliance violations.
10. Lost or Damage. CLIENT will be liable for loss or damage to items intended for transport, which are in CLIENT’S possession or under its dominion and control.
11. Control and Exclusive Use. In performing services under this agreement, CLIENT will direct the operation of any equipment in all respects and will determine the means of performance including but not limited to such matters as choice of any routes, points of service of equipment, rest stops, and timing and scheduling of customers deliveries. The parties intend to create an independent contractor relationship and not an employer-employee relationship.
12. Laws. CLIENT agrees to comply with all federal, state and local laws, rules, and regulations pertaining to its performance under this agreement.
13. Disclosure. COMPANY is not a freight broker, but an administrative agent acting as liaison between licensed motor carrier and licensed freight broker. Agreement between parties is non-exclusive, therefore COMPANY can service other carriers and CLIENT can use other dispatch services!
14. Notice. Any written notice required by the terms of this agreement shall be given either by email, personal delivery or by certified mail.
15. Invalidity. In the event any provision of the agreement shall be held to be invalid, it shall not affect the validity of the remainder of this agreement.
16. Complete Agreement. This agreement contains the entire understanding between the parties and supersedes any prior agreement3W the parties concerning the subject matter of this agreement.
COMPANY’s DESIGNATION: By signing this Exhibit Client provides written consent to the Company to act ontheir behalf as Dispatcher (and be listed on Carrier-Broker Agreements as Dispatcher or Managerof Logistics/Operations). In such capacity Company has the right to perform following duties:

- Contact Brokers on behalf of the Carrier to acquire information on available freight and conditions

- Sign Broker-Carrier agreements on behalf of the Carrier

- Negotiate the rates and sign rate confirmations on behalf of the Carrier

- Set up accounts with leading load boards for purpose of searching and “truck posting” for Carrier

- Conduct communication with Freight Brokers on behalf of the Carrier

- Handle back office support

- Conduct broker/carrier credit check
COMPANY’s COMPENSATION:

By signing this Exhibit Client agrees to pay Company every week as following

(please select one):
Pay Options*

10% of the loads gross revenue booked by the Company for Client Total of 10% of the loads gross revenue booked by the Company from Monday through Sunday will be charged the following Monday to Client’s credit or debit card.
DEBIT CARD PAYMENT AUTHORIZATION FORM
I Type a label, hereinafter called CARRIER do hereby authorize PICTUREJASS LLC, hereinafter called DISPATCH, to initiate a weekly debit entry for the amount listed below, on the dates listed below, to the credit card account indicated below, in consideration of the dispatching service provided to me. I understand that my signature on this authorization form, along with a photocopy of the front and the back of both my credit card, as well as my driver license, will allow me the convenience of not having to produce these items for impression at the time of service.
Card information
Card number   Type a label*
Exp   Type a label*
CVV   Type a label*
ZIP CODE: Type a label
Please Select One*

VisaMastercardDiscoverAmex
Authorized Weekly Payment Amount*

10% LoadsOther
This authorization is to remain in full force and effect until the ending date listed above. I understand that I will be notified via email when DISPATCH debit my account each week. I understand that if the load is tendered and accepted by me, I am responsible for paying DISPATCH as set out above. Any revocation shall not be effective until DISPATCH is notified by CARRIER in writing to cancel this automatic payment authorization, in such time and in such a manner as to afford DISPATCH a reasonable opportunity to act on it.
Card Holder's Signature

Clear
Authorization Date

MonthDayYear
Date
Card Holder's Email
example@example.com
NO BACK SOLICITATION.

CARRIER shall not knowingly solicit freight shipments (or accept shipments) during the term of this Agreement and for a period of 24 month(s) following termination of this Agreement for any reason, from any shipper, consignor, consignee, or other customer of DISPATCHER, where (1) the availability of such traffic became known to CARRIER as a result of DISPATCHERS efforts, or (2) the traffic was first tendered to CARRIER by DISPATCHER, either directly or indirectly. If you fail to follow the terms of this agreement by any means you will be charged a fee of $100 by DISPATCHER.
I agree to the terms of the back solicitation clause.*

YesNo
LIMITED POWER OF ATTORNEY
BE IT KNOWN, that Company Name with MC# and DOT# has made and appointed, and by these presents does make and appoint PICTUREJASS LLC true and lawful attorney for Company Name place and stead, for the following specific and limited purposes only:
To contract loads and to perform all acts and things necessary to contract loads.

giving and granting said attorney, full power and authority to do and perform all and every act and thing whatsoever necessary to be done in and about the specific and limited premises (set out herein) as fully, to all intents and purposes, as might or could be done if personally present, with full power of substitution and revocation, hereby ratifying and confirming all that said attorney shall lawfully do or cause to be done by virtue hereof. This power of attorney is to remain in full force until revoked by me in writing and received in mail or email by PICTUREJASS LLC to the company mailing address or the company email address.
Signature

Clear
Name

First NameLast Name
Date

MonthDayYear
Date
Witness Signature

Clear
Name

First NameLast Name
Date

MonthDayYear
Date
Carrier Profile Information

Please complete this form giving us the information that best fits your company. The more information the better we are able to assist you. This information is for our use only and will not be shared without your consent.
Email*
example@example.com
Company Name
Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of License (CDL A, B, C, Non-CDL)
MC#
EIN#
DOT#
Any Certifications
Working Preference

IntrastateInterstate
Please List Your Type Of Equipment
Please List Your Length Of Equipment
Trailer #
HotShot Make/Model
Trailer Type
GVWR
Max Load Weight You Prefer
Etracks
ELD Provider
Load Bars?
Straps? Type and Length
Air Ride
Pads
Tarps? Type and Length
LxWxH of The Truck
Commodity Types or Restrictions
Expected Rate To Receive/ Or Break Even Point
Daily Operational Driving Radius
Days they would like to drive?

SundayMondayTuesdayWednesdayThursdayFridaySaturday
Any other information they would like to share
This agreement will be signed by the carrier and electronically delivered to the Dispatcher. Payments are due to the Dispatcher for services rendered and are not contingent on outstanding payments due to the carrier for loads that he or she has hauled for the Shipper or Broker.

Your electronic signature below confirms that you have agreed to all of the terms. Failure to pay the Dispatcher for services rendered will result in immediate termination of contract and services unless otherwise determined by the Dispatcher.
Drivers License

Cancelof
Print Carrier Authorized Agent Name
Title
Signature

Clear
Company Acceptance
FULL NAME

Jasmine Jones
Date

MonthDayYear
Date
Should be Empty:

Carrier Profile Form

LIMITED POWER OF ATTORNEY

Carrier Profile Information

Company Acceptance