Dispatcher - Carrier Agreement

Collect an independent carrier's operational details, equipment, and references to formalize their working agreement with a freight dispatcher.

Use this template

Full Name

Nombre

Apellido

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Phone Number

E-mail

Carrier Information

How did you hear about us?

Other (please specify)

MC #

Max Weight Limit

Please list your securement equipment (tarps, straps, chains, lift gate, ramps, etc.)

Insurance information: your agent's phone and email (so we can request your certificate of insurance for clients/brokers)

Factoring company info: contact, email, and phone (also state how credit on your clients/brokers will be vetted). If you don't use factoring, write N/A

Tell us about yourself and your goals: where do you see your company in 2 years, 5 years, etc.?

How often do you want to be home?

What areas will you drive?

Local Regional Over the road (OTR)

Would you be willing to recommend us?

Yes No

Please upload your W-9, insurance, authority, and Notice of Assignment (from your factoring company, if applicable)

Max 10 MB per file

Driver's Name and Cell Phone (if you will not be driving)

Section

Please enter the agreed dispatching fee (the default fee is 10% if not otherwise discussed)

Your Company Name

Signature

Sign here

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Dispatcher - Carrier Agreement

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