FSS DISPATCHING AGREEMENT PACKAGE

CARRIER PROFILE

Please take a moment to answer the following questions. The better informed we are the better we will be able to assist you. This form can be updated at any time by notifying us. This information is for our use only and will not be released to any
third party without your express written permission.

PART 1: CARRIER INFORMATION

CARRIER *

First NameLast Name

BUSINESS NAME*

Company Name (Including DBA, if any)

Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Preferred Contact Number*

Please enter a valid phone number.

Preferred Email*

example@example.com

Fax

Business Fax #, if any

Business Website

Business Website, if any

TRUCK NUMBER*

TRUCK LICENSE PLATE NUMBER*

TRAILER NUMBER*

MC#*

DOT#*

TWIC CERTIFIED:*

HAZ MAT CERTIFIED:*

PART 2: EQUIPMENT SECTION

HOW MANY TRUCKS DO YOU OWN?*

NUMBER OF OWNER OPERATORS?*

NUMBER OF TEAMS?*

NUMBER OF VAN TRAILERS?*

NUMBER OF REEFER TRAILERS?*

NUMBER OF FLATBED TRAILERS? *

LIST OTHER TRAILERS *

INCLUDE THE NUMBER OF EACH TRAILER

VAN TRAILER SIZE?*

REEFER TRAILER SIZE?*

FLATBED TRAILER SIZE?*

ADDITIONAL EQUIPMENT*

MINIMUM RATE PER MILE*

How much do you charge min. to move your truck?

MAXIMUM PICKS*

How many loads are you willing to pickup per day?

MAXIMUM DROPS*

How many loads are you willing to deliver per day?

MAXIMUM WEIGHT*

What is the max. weight that you are willing to carry?

MINIMUM WEIGHT*

What is the min. weight that you are willing to carry?

MAXIMUM DISTANCE (ONE WAY)*

What is the max. distance you are willing to travel, ONE WAY?

DRIVER TOUCH*

Are you willing to touch the load?

WHAT IS YOUR DESIRED HOURLY 'WAIT PAY' (DETENTION PAY RATE)?*

How much would you prefer to get paid per hour, if you were required to wait for loading or unloading?

TELL US MORE ABOUT YOUR PREFERENCES

PLEASE LIST ALL BROKERS THAT YOU HAVE PREVIOUSLY WORKED WITH

DISPATCH TO CARRIER AGREEMENT

This Agreement is made on this {dateOf} of form submitted by and between said CARRIER and "Jason Lambert/FSS Dispatching".

DISPATCHER is a transportation dispatcher handling the necessary paperwork between SHIPPERS and/or BROKERS and the CARRIER in order to secure "Freight" for said CARRIER.

WHEREAS, CARRIER is a Motor CONTRACT Carrier subject to the jurisdiction of the ICC: NOW THEREFORE, in consideration of the promises and covenants hereinafter contained it is mutually agreed by and between parties' hereto as follows:

I, {carrier}, the Owner/Operator of {truckNumber} Trailer Number {trailerNumber} , Motor Carrier Number {mc} and Department of Transportation {dot} , hereby grants authorization or permission to: JASON LAMBERT/FSS DISPATCHING to act as my Dispatcher/Logistics Manager for the sole purpose of searching for and booking loads, processing all brokerage paperwork (BROKER/CARRIER AGREEMENTS AND RATE CONFIRMATIONS) and obtaining and/or submitting all necessary documents required (COPY OF CARRIER’S MC AUTHORITY LETTER, COPY OF CARRIER’S CERTIFICATE OF INSURANCE, COPY OF CARRIER’S W9, and COPY OF CARRIER’S NOTICE OF ASSIGNMENT, if the carrier has a factoring company) in order to expedite loads and dispatch via telephone, fax or e-mail for my truck, License Plate#, {truckLicense}.

{carrier}/{businessName} agrees to pay JASON LAMBERT/FSS DISPATCHING, a flat rate fee of 10% per load. You will be invoiced once weekly, which the invoice will be sent out Friday, for all your weekly loads, and payment will be due no later than Sunday.

ALL BILLING, INVOICING, AND COLLECTIONS OF REVENUE FROM SHIPPERS, BROKERS AND/OR FACTORING COMPANIES ARE THE SOLE RESPONSIBILITY OF THE CARRIER OR TRUCKING COMPANY, UNLESS DISPATCHING COMPANY AND CARRIER OR TRUCKING COMPANY HAVE ARRANGED AND AGREED UPON ADDITIONAL SERVICES PROVIDED TO THE CARRIER OR TRUCKING COMPANY BY THE DISPATCH COMPANY.

If revenue for a shipment or shipments is uncollectible, JASON LAMBERT/FSS DISPATCHING will be held harmless and no penalty or deduction of fees will be made.

{carrier}/{businessName} 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.

Additionally, {carrier}/{businessName} 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.

JASON LAMBERT/FSS DISPATCHING will be held harmless in the event of any and all claims.

CONTRACT LENGTH OPTIONS*

How long do you grant us to act as your Dispatcher?

Signature*

DATE OF CONTRACT*

Date of Contract

Hour MinutesAM/PM Option

LIMITED POWER OF ATTORNEY FORM

BE IT KNOWN, that {carrier} with an MC number of {mc} and DOT number of {dot} has made and appointed, and by these presents does make and appoint JASON LAMBERT/FSS DISPATCHING, true and lawful attorney for, place and stead, for the limited and specific purpose of contracting loads of freight to be hauled by, giving and granting said JASON LAMBERT/FSS DISPATCHING, 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 terms (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 thereof. This power of attorney is to remain in full force and effect until revoked by me in writing. Such revocation is to be emailed to:
JASON LAMBERT/FSS DISPATCHING JLambert@fssdispatching.org

CARRIER/TRUCKING COMPANY NAME:{carrier} / {businessName}
Signature:{signature105}
Printed Name: {carrier}
Date: {dateOf}

THE FOLLOWING WAS STATED:

Jason Lambert/Fss Dispatching will act as your dispatcher by performing the following
duties:
➢ Searching for loads
➢ Booking loads
➢ Processing all brokerage paperwork (broker/carrier agreements and rate
confirmations)
Jason Lambert/Fss Dispatching will NOT be responsible for billing, invoicing, and collections of payment from shippers, brokers and/or factoring companies.
Jason Lambert/Fss Dispatching will NOT be responsible if payment for a shipmentis
uncollectible.
Jason Lambert/Fss Dispatching dispatcher’s fee can NOT be deducted or otherwise penalized, in the case of uncollectible payments for shipments.
Jason Lambert/Fss Dispatching will NOT be responsible in the event of ANY or ALL
claims.
Jason Lambert/Fss Dispatching asked you to provide a copy of the following
documents:
➢ Your MC Authority Letter
➢ Certificate of Insurance
➢ W9 Tax Form
➢ Notice of Assignment (If you have a factoring company)
Jason Lambert/Fss Dispatching informed you that you must maintain all proper licenses and permits to legally conduct business as a motor carrier whether in-state or nationally.
Jason Lambert/Fss Dispatching informed you that you must maintain $1 Million General Liability Insurance and $100,000 Insurance at the amount set forth by your state.
Jason Lambert/Fss Dispatching asked you to give your permission to sign YOUR NAME on all brokerage paperwork to confirm bookings and pay rates.
To revoke your permission, allowing Jason Lambert/Fss Dispatching to sign YOUR NAME on all brokerage paperwork, you must do so in writing by emailing Jason Lambert/Fss Dispatching at JLambert@Fssdispatching.org.
It is your responsibility to pay Jason Lambert/Fss Dispatching 10% per load no later than Sunday of each week.

Signature*

DATE OF CONTRACT*

Date

Hour MinutesAM/PM Option

We must have the following documents to start working for you. Please upload them here, or email or fax them to us separately.

1. A COPY OF YOUR MC AUTHORITY LETTER

2. CERTIFICATE OF INSURANCE

3. COMPLETED W9 FORM

4. NOTICE OF ASSIGNMENT (IF YOU CURRENTLY WORK WITH A FACTORING COMPANY)

Upload all documents here

DISPATCHER-CARRIER

CARRIER DELIVERY PREFERENCES

SIMPLE TERMS

CREDENTIALS & DOCUMENTS