BGibson Logistics LLC Dispatch Agreement
Thank you for choosing BGibson Logistics LLC. Please complete the information below to create your account. When information is submitted, we can get you loaded and rolling. Please make sure you have your Motor Carrier Authority (MC), W-9, Proof of Insurance, Notice of Assignment (NOA) or voided check handy. You will need to upload those documents. If you have any questions about this form, please contact (480)410-3345 or e-mail bgtrucklogistics@gmail.com.
Dispatch Fee: 10% of weekly gross
FIRST AND LAST NAME
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First Name
Last Name
COMPANY NAME
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COMPANY ADDRESS
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COMPANY MAILING ADDRESS
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COMPANY E-MAIL
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COMPANY PHONE NUMBER
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EMERGENCY CONTACT NAME AND NUMBER
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MOTOR CARRIER NUMBER (MC #)
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DOT #
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EMPLOYER IDENTIFICATION NUMBER (EIN)
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TWIC CERTIFIED? YES OR NO?
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HAZMAT CERTIFIED? YES OR NO?
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EQUIPMENT TYPE
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Please Select
FLAT BED
DRY VAN
POWER ONLY
REEFER
BOX TRUCK
HOT SHOT
CARGO VAN
SPRINTER VAN
SUPPLIES:
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ARE YOU ELD COMPLIANT? YES OR NO - IF YES WHAT SERVICE DO YOU USE?
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FACTORING NAME:
FACTORING COMPANY ADDRESS:
FACTORING PHONE NUMBER:
INSURANCE COMPANY NAME:
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INSURANCE COMPANY PHONE NUMBER:
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INSURANCE COMPANY E-MAIL:
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PLEASE UPLOAD YOUR MOTOR CARRIER AUTHORITY LETTER (MC), PROOF OF INSURANCE, W-9, NOTICE OF ASSIGNMENT (NOA) OR VOIDED CHECK
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LIMITED POWER OF ATTORNEY FORM
This Limited Power of Attorney is made and entered into on ___(date)___, between: BGibson Truck Logistics, a company established under the laws of the state of Arizona, and __(carrier name)_. Hereinafter called motor carrier company with DOT #________ , appoints BGibson Truck Logistics as my attorney-in-fact (agent). BGibson Truck Logistics agents, shall have full power and authority to act on my behalf. This power and authority shall authorize BGibson Truck Logistics to manage and conduce affairs and to exercise all my legal rights and powers, including all rights and powers that I may acquire in the future. BGibson Truck Logistics shall include, but not to limited to, the power to:Professional dispatch services, including contact drivers, shippers, and brokers on my behalf for cargo/freight and Transfer of Documents (Carrier Packet, Rate Confirmations, Insurance Certificates, Invoices, etc.) to broker/shipper. Sign and execute rate confirmations for freight and collect all payment dues on my behalf. This Power of Attorney shall be constructed broadly as a General Power of Attorney. The listing of specific power is not intended to limit or restrict the general powers granted in the Power of Attorney in any manner. BGibson Truck Logistics shall not be liable for willful misconduct or the failure to act in good faith, while acting under the authority of this Power of Attorney. I authorize BGibson Truck Logistics to indemnify and hold harmless any third party who accepts and acts under this document. This Power of Attorney shall become effective immediately and shall remain in full force and effect until revoked by me in writing. Such revocation is to be emailed to: bgtrucklogistics@outlook.com
TODAYS DATE:
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DOT #:
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COMPANY NAME:
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SIGNATURE:
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