New Authority Carrier Set Up Form
Our New Authority Carrier Set-Up simplifies the process of connecting carriers with a trusted network of brokers who work with new authorities. We’ll sign you up with 10 reliable brokers ready to help you get your truck moving from day one!
Company Name
*
Owner's Name
*
First Name
Last Name
Fed ID #
*
DOT#
*
MC#
*
Company Phone
*
Please enter a valid phone number.
Fax
If applicaple
Company Email
example@example.com
Dispatch Contact
*
Dispatch Phone
*
Dispatch Email
*
Claims Contact
*
Claims Phone
*
Claims Email
*
example@example.com
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (If different from physical)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Remit Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Power Units (tractors)
*
Equipment Type(s)
*
Additional Services
Haz-Mat (must provide current HZ permit)
Warehouse/Crossdocking
Team Service
Tow Away Service (Tractor only)
Pallet Exchange
Refrigerated
Canadian (provide current authority for CN)
Mexican (provide current authority for MX)
Drop Trailer(s)
Lift gate Truck(s)
Produce Carrier
LTL
SCAC Code (If applicable)
ELD Brand
*
RMIS Code (If applicable)
Factoring Company Corporate Contact
Name, phone number, and email
Completed W9, Authority Letter, NOA or Voided Check, & COI
*
Browse Files
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of
Additional FilesEx: Hazmat permit, Diverse-owned Business Documentation, etc.
Browse Files
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Choose a file
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I hereby certify I am the owner of the company listed above and authorize Loyalty Dispatch & Logistics, LLC to represent me in carrying out the services I have acquired. I acknowledge that my state might mandate a state-specific power of attorney for Loyalty Dispatch & Logistics, LLC to operate at the state level. I commit to providing any supplementary information promptly (within 48 hours of request) and acknowledge that Loyalty Dispatch & Logistics, LLC holds no responsibility for inaccuracies or late fees due to delayed information. All communication will be conducted via email (dispatch@loyaltydispatchlogistics.com). I acknowledge the absence of a refund policy.(required)
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New Authority- Carrier Setup
Setup w/ 10 brokers that will let you haul on Day 1 of your active authority
$
400.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit & Pay
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