Partnership/Carrier Agreement Form

1

Legal Name of Carrier/Owner-Operator:* This field is required.

First Name

Last Name

2

Name of trucking company(if applicable)

3

Operating Authority#(if applicable)

4

Common/Contractre: Authority

COMMON

CONTRACT

5

USDOT Number:* This field is required.

6

EIN/Tax Identification #:* This field is required.

7

Physical Address:* This field is required.Include City State and zip

8

Mailing Address ( if applicable)

9

Primary Contact Person:* This field is required.

First Name

Last Name

10

Primary Contact Email* This field is required.

example@example.com

11

Primary Contact Phone:* This field is required.

Please enter a valid phone number.

12

Secondary/Emergency Contact (If applicable)

First Name

Last Name

13

Secondary Phone Number

Area Code

Phone Number

14

Secondary Email

example@example.com

15

Preferred Method of Communication:* This field is required.Best form of contact

phone

text

email

16

Operating Authority:* This field is required.

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Max. file size: 10.6MB

17

Insurance Information* This field is required.Upload GENERAL LIABILITY, AUTO, CARGO, WORKERS COMP

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Max. file size: 10.6MB

18

W-9 Form:* This field is required.

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Max. file size: 10.6MB

19

Direct Deposit Information: (Please attach a voided check or bank letter)* This field is required.For payment purposes

ROUTING

ACCOUNT

BANKING INSTITUTION

20

Equipment Information:* This field is required.

NUMBER OF TRUCKS

YEAR MAKE AND MODEL FOR EACH VEHICLE

VIN NUMBER

21

Trailer Information (for each trailer)* This field is required.

Please enter a number

YEAR MAKE MODEL

VIN NUMBER

ADDITIONAL EQUIPTMENT AND TRAILER INFO

22

Type of Trailer (e.g., Dry Van, Reefer, Flatbed, Lowboy)

LENGTH

WIDTH

HEIGHT

WEIGHT CAPACITY

TRAILER TYPE

23

Type of Trailer (e.g., Dry Van, Reefer, Flatbed, Lowboy)

LENGTH

WIDTH

HEIGHT

WEIGHT CAPACITY

TRAILER TYPE

24

Specific Equipment/Attachments (if applicable):e.g., Straps, Chains, Binders, Temperature Control Units, Liftgates)

25

Maintenance Schedule/Practices:* This field is required.(Briefly describe)

26

ELD Provider:* This field is required.Provide ELD Provider information here

27

Are your trucks equipped with GPS tracking?* This field is required.

YESNO

28

If yes, provide platform/login details (if you are willing to share for better dispatching):

29

Preferred Operating Regions/States:* This field is required.

30

Regions/States to Avoid:

31

Types of Freight Preferred(e.g., Dry Goods, Refrigerated, Flatbed Commodities, Oversized)

32

Types of Freight to Avoid

33

Do you have authority to haul hazardous materials?

YESNO

34

Do you have experience with specific industries or commodities?

YESNO

35

If yes, please list:

36

Typical Availability/Hours of Operation:

37

Home Base/Typical Layover Locations:* This field is required.

38

Do you prefer round trips or one-way loads?

39

Minimum Acceptable Rate Per Mile (Truckload):* This field is required.

40

Minimum Acceptable Rate (LTL/Partial)* This field is required.

41

Do you factor your invoices?* This field is required.

YESNO

42

Type a If yes, provide factoring company name and contact information:

43

Notice of Assignment* This field is required.Upload a copy of the Notice of Assignment from your current Factoring Company

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Max. file size: 10.6MB

44

Do you have any specific requirements for loading/unloading?(e.g., Driver assist required, No touch freight)

45

Are you willing to run team operations?Do you have a driving partner?

YESNO

46

Do you have any endorsements?(e.g., Hazmat)? If yes, please list:

47

What is your typical downtime for maintenance or personal reasons?

48

Driver Requirements/Preferences (if applicable):(e.g., Home time needs, preferred routes)

49

How many drivers do you currently employ (if applicable)?

50

Are you currently working with other dispatchers?

YESNO

51

If yes, please explain the arrangement:* This field is required.Feel free to upload your current agreement for review

52

LOAD BOARD LOG INThis allows us to minimize time, and better communication, add website and login

53

What are your expectations from a dispatching service?Select all that apply

Load booking

Route Planning

Document Preparation/Assistance

Negotiation

Consultation

Driver Recruitment

Invoicing

54

How often do you expect updates on available loads?

55

What is your preferred method for receiving load information?(e.g., Phone, Email, Text, App)

56

Have you received and completed a copy of our Dispatch/Operations agreement?* This field is required.This agreement spells out all services offered to you and your company as part of our daily duties.

YESNO

57

Have you read and understood the terms of our dispatch agreement?

YESNO

58

Are there any additional services you require from us?

59

Previous Broker/Shipper References(Name & Contact Information):

60

Other Business References

61

Additional Comments/Information:Please provide any other information you feel is relevant to our dispatching services:

62

By submitting this questionnaire, I certify that the information provided is true and accurate to the best of my knowledge. I understand that this information will be used for the purpose of providing dispatching and operational services.

63

Signature* This field is required.

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64

Title* This field is required.Your position with the company

65

Date* This field is required.

Date