Dispatcher Packet

What we need to do business and get you a load.

1. Copy of MC Authority.
2. Copy of your insurance certificate and a phone number for your insurance company.
3. Signed W-9 form.
4. Signed Contract for services.
5. Company profile completed.
6. Your factoring company's name, address, and contacts phone number.

Please complete the following information so that we may better serve you. **You will receive an invoice faxed to
the location you selected; you pay only the amount of the invoice -no hidden charges ever.

Company's Name: _________________________________________________

Address: ___________________________________________________________
City: ______________________ State: _________________ ZIP: _____________

Company's Phone Number: _________________

Cell Phone Number: _________________
Fax Number: _________________
Insurance Company's Name: __________________________________
Insurance Company's Phone# _________________
Insurance Company Contact: __________________________________
Factoring Company's Name: __________________________________
Address: ___________________________________________________
City: _________________ State: _________________ Zip: _________________

Phone Number and Contact Name: _________________ _________________________________

***All service fees are collected at time of completed transactions.
 Dispatcher - Carrier Agreement

This Agreement is made this _____ day of 20_ , by and between "[YOUR COMPANY NAME] ", hereafter referred to as
DISPATCHER, and, hereinafter referred to as CARRIER. WHEREAS, DISPATCHER is a transportation dispatcher handling
the necessary paperwork between a SHIPPER/BROKER and the CARRIER to secure "CARGO' 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 convents hereinafter contained it is mutually agreed by and between parties hereto as follows:

OBLIGATIONS OF DISPATCHER
1. DISPATCHER agrees to handle paperwork, phone, fax calls to, from the SHIPPER/BROKER to tender commodities
shipments to CARRIER for transportation in interstate commerce by CARRIER between points and places within the scope of
CARRIER'S operating authority.
2. DISPATCHER bears no financial or legal responsibility in the transaction between the SHIPPER/BROKER, CARRIER
agreement.
OBLIGATIONS OF CARRIER
1. CARRIER agrees to pay DISPATCHER percent (...%) of the face value of the contract between the SHIPPER/BROKER,
CARRIER as stated on the load rate confirmation sheet. Carrier further agrees to pay DISPATCHER at the time of securing
cargo.
2. CARRIER gives DISPATCHER authority to provide his signature for rate confirmation sheets, invoices, and associated
paperwork necessary for securing cargo and billing purposes. The terms of this agreement shall be perpetual, provided that either
party may terminate the same by giving 30-day written notice to the other.
3. SHIPPER/BROKER agrees to pay CARRIER promptly, following receipt of a freight bill and proof of delivery of each
shipment to its assigned destination, free of damage or shortage. The amount to be paid by SHIPPER or BROKER to CARRIER
shall be established between parties on a per shipment basis before the commencement of each shipment. A load confirmation
including details of shipment and revenue to be paid will be supplied via FAX by SHIPPER/BROKER to CARRIER.
Confirmation will be signed by DISPATCHER and returned via FAX to SHIPPER.
4. CARRIER shall be liable for loss, damage, or liability occasioned by the transportation of property arranged by
DISPATCHER, SHIPPER, or BROKER while in the possession of the carrier.
5. CARRIER agrees to hold DISPATCHER, SHIPPER, BROKER harmless from any liability for personal injury or property
damage occurring during the operation conducted by CARRIER according to this agreement.
6. CARRIER will be responsible to comply with all applicable state and federal regulations about the operation of a motor
carrier.
7. CARRIER and DISPATCHER agree that DISPATCHER, at great expense, has developed a broad customer base of shippers,
receivers, and brokers that is essential to the successful operations of his company. CARRIER and DISPATCHER agree that
disclosure of the identity of one or more of the companies’ said customers to CARRIER constitutes valuable consideration.
During the term of this AGREEMENT and for two (2) years from its termination, CARRIER shall not, directly or indirectly,
solicit or do business years from its termination, CARRIER shall not directly or indirectly, solicit or do business involving
transportation or of a warehousing nature with any the companies’ customers who are serviced by CARRIER as a result of this
AGREEMENT unless otherwise agreed by the parties in writing.
8. Carrier acknowledges that the customer information being provided by DISPATCHER is the sole and exclusive property of
DISPATCHER and that neither it, nor any employee, agent, or subcontractor shall back-solicit, directly or indirectly,
communicate or perform any service for compensations for any account of DISPATCHER which has previously tendered to
CARRIER for transportation, nor shall it pass on or reveal any customer information obtained to any other person or company.
9. Solicitation prohibited under this AGREEMENT means participation in any conduct, whether direct or indirect, the purpose of
which involves transportation and/or handling of property by CARRIER for which CARRIER does, or did in the past, provide
such service for that customer under arrangements first made or procured by DISPATCHER. Solicitation includes conduct
initiated or induced by CARRIER, or accepted by CARRIER, upon inducement by DISPATCHER efforts.
10. If CARRIER should perform services of a transportation or warehousing nature for compensation for any DISPATCHER
customer without prior documented authorization from DISPATCHER during the applicable period in violation of this
AGREEMENT CARRIER shall pay to DISPATCHER within ten (10) days of each such violation an amount equal to (10%) of
all revenues invoiced by CARRIER to the solicited customer. Where a dispute or disagreement arises, both parties agree to tender
the issue to binding arbitration in the "State of Your State".
11. CARRIER acknowledges that a breach of this provision will give rise to immediate and irreparable injury to DISPATCHER,
which is inadequately compensated in damages. Accordingly, CARRIER agrees that DISPATCHER is entitled to obtain
injunctive relief against the breach or threatened breach by CARRIER of this obligation, in addition to any other legal remedies,
which may be available. CARRIER further acknowledges that the precise damages DISPATCHER would sustain out of any
breach of this covenant may be difficult to ascertain and agrees that it shall pay as damages, twenty-five (25%) percent of the
aggregate of all rates and charges assessed by CARRIER for transportation services provided to any account of DISPATCHER
that is handled in contravention of this agreement, plus liquidated damages of ten thousand ($10,000.00) dollars.
12. CARRIER agrees that it will function under terms of this agreement strictly as a duly permitted contract carrier, and hereby
waives any rate provisions, which may be contained in its published carrier tariffs.
13. This agreement shall be deemed to be effective on the first date that CARRIER, DISPATCHER, and SHIPPER commence
business together, and the parties hereby agree that the provisions herein properly express and memorialize the complete
understanding as contained in any prior agreement either written or verbal.

[YOUR COMPANY NAME]. CARRIER:

By: [YOUR NAME] BY: [YOUR CLIENT’S COMPANY NAME].
TITLE: [YOUR TITLE] TITLE: [YOUR CLIENT’S NAME].
DATE:___________ DATE:___________
 Credit Card Authorization Form
[YOUR COMPANY NAME]
Address: 1234 Main St |City, ST 90210
Phone: (800) 555 - 5555 | Fax: (877) 123-4567

Cardholder Name: _____________________________________________________________

Billing Address: _____________________________________________________

Credit Card Type: _____ Visa _____ M/C ____ Discover _____ Amex

Credit Card Number: _________ __________ ________ ___________

Expiration Date: ____ / ____

Cvv Code: ________ (3 Digits Located On The Back Of The Credit Card)

I authorize [YOUR COMPANY NAME] to charge the dispatch fees for the loads I have accepted from [YOUR COMPANY
NAME] From the credit card listed above, as stated in the dispatch fee agreement.

I agree to pay for this purchase in accordance with the issuing bank cardholder agreement.

Cardholder – Please Sign And Date

Signature: _____________________________________________________

Print Name: _____________________________________________________

Date: ____ / ____ / ____

Return The Completed And Signed Form To The Following: [YOUR COMPANY NAME] Address: 1234 Main St |City,
ST 90210 Phone: (800) 555 - 5555 | Fax: (877) 123-4567 Email: [email protected] Web: www.mywebsite.com

Hot Shot/ Box Truck carriers only

$75.00 recurring monthly fee (first day of each month) this grants you your first dispatch of every month free $50.00 per dispatch
after 1st monthly free dispatch.

Recurring Payment Authorization Form

A scheduled automatic payment will be deducted from your credit card on file (Visa, MasterCard, American Express, or
Discover Card). Just complete, sign, and return this form to get started!

Here’s how the Recurring Payment will work. You authorize the recurring fee to your credit card. You will be charged the $75.00
monthly fee. A receipt for your payment will be emailed to you and the charge will appear on your credit card from [YOUR
COMPANY NAME]. You agree that no prior notification will be needed from [YOUR COMPANY NAME] of the monthly
recurring fee. Unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the
payment being collected.
Please complete, sign and return:

I ____________________________ (full name) authorize [YOUR COMPANY NAME] to charge my credit card As indicated
below for the amount of $75.00 on the 1st day of each Month for payment of my dispatch agreement with [YOUR COMPANY
NAME], this fee also grants me the first dispatch of the current month for free.
(No Charge for 1st dispatch of the month, after the 1st dispatch of the month is free, all other dispatches will be charged at a rate
of $50.00 per dispatch).

Billing Address ____________________________ Phone # ________________________

City, State, Zip ____________________________ Email ________________________
SIGNATURE ____________________________ DATE __________________________

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify [YOUR COMPANY
NAME]. in writing of any changes in my account information or termination of this authorization at least 15 days prior to the
next billing date. If the above-noted payment dates fall on a weekend or holiday, I understand that the payments may be executed
on the next business day.
I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above
noted periodic transaction dates. In the case of a Charge NOT Approved I understand that [YOUR COMPANY NAME] may
at its discretion attempt to process the charge again within 30 days, and agree to an additional $35.00 charge for each attempt
which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of the
Credit Card charges to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this
credit card and will not dispute these scheduled transactions with my credit card company; so long as the transactions correspond
to the terms indicated in this authorization form.

LIMITED POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS that I [YOUR CLIENT’S NAME], hereby make, constitute, and appoint

[YOUR CLIENT’S COMPANY NAME], as my true and lawful attorney in fact for me and in my name, place, and

stead; for the following purposes only:

● To transfer documents

● Accept loads

● Discuss my accounts and invoice customers

● Modes of communication for requesting and receiving information may include telephone, email, fax, or

mail.

Name: [YOUR CLIENT’S NAME]

Signature: [YOUR CLIENT’S SIGNATURE]

Date: [TODAY’S DATE]

MC# [YOUR CLIENT’S MC NUMBER]

 CARRIER PROFILE FORM

To assist us in the set-up of your account for payment please take a few minutes to complete the form below. A copy of your
Operating Authority, COI with [YOUR COMPANY NAME]. as the holder, W-9 form, and Dispatcher - Carrier Agreement
must also be attached to this form to ensure that your account is set up accurately.

Company Legal Name: __________________________________________________________________________

Doing Business As: ______________________________________________________________________________

Physical Address: ____________________________________ City: ______________________ State: ___ Zip: ____

Mailing Address: ________________________________ City :_______________________ State:_____ Zip: ______

24 hour primary phone number: __________________ Office: ___________________ Fax: ___________________

Email: ____________________________

Accounts Receivable Contact Name & Phone: ________________________________________________ Dispatch

Contact Name & Phone: _______________________________________________

Are your receivables factored or assigned? _________Yes _________ No If yes, please fill out the following information:

Name of Factoring Company: _____________________________ Telephone Number: _______________________

Address to Mail Payment: ________________________________

MC#:_____________________ EIN#:____________________ USDOT#:_________________

Equipment Information Total # of Tractors:___________________________________

Total # of Trailers:_____ Reefers _____ Vans _____ Flatbeds _____

[YOUR COMPANY NAME] Phone: (800) 555 - 5555 | Address: 1234 Main St |City, ST 90210
Fax: (877) 123-4567
Email: [email protected] | Web: www.mywebsite.com