Dispatch Agreement DISPATCH SERVICE AGREEMENT Complete the Online Service Agreement Below & Submit. Submit 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) email: dispatch@eznoutlogisticsllc.com (*Required Information Needed) – I, Name * (the carrier), the Owner/Operator of Truck Number * Trailer Number * Motor Carrier Number(MC) * and Department of Transportation Number(DOT), hereby grants authorization or permission to: EZN OUT LOGISTICS LLC 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) via email to dispatch@eznoutlogisticsllc.com in order to expedite loads and dispatch via telephone, or e-mail for my truck, License Plate#, * in the state of * INSURANCE COMPANY NAME Include with carrier copies: * Phone * INSURANCE COMPANY FAX NUMBER * INSURANCE COMPANY EMAIL ADDRESS * ALL BILLING, INVOICING, AND COLLECTIONS OF REVENUE FROM SHIPPERS, BROKERS AND/OR FACTORING COMPANIES ARE THE SOLE RESPONSIBILITY OF THE CARRIER OR TRUCKING COMPANY, FACTORING COMPANY INFORMATION – FACTORING COMPANY NAME FACTORING COMPANY EMAIL FACTORING COMPANY PHONE NUMBER CARRIER’S BANK INFORMATION – CARRIER’S BANK NAME CARRIER’S BANKTYPE OF ACCOUNT CHECKING SAVINGS CARRIER’S BANK ACCOUNT & ROUTING NUMBER UNLESS EZN OUT LOGISTICS LLC COMPANY AND CARRIER OR TRUCKING COMPANY HAVE ARRANGED AND AGREED UPON ADDITIONAL SERVICES PROVIDED TO THE CARRIER OR TRUCKING COMPANY WITH EZN OUT LLC DISPATCH SERVICE COMPANY. If revenue for a shipment or shipments is uncollectible, EZN OUT LOGISTICS LLC DISPATCH COMPANY will be held harmless and no penalty or deduction of fees will be made. The Carrier/Trucking Company 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/Trucking Company agrees to maintain general liability ( $750,000 and cargo insurance ($100,000) at the amounts set forth by the home state of the carrier/trucking company. EZN OUT LOGISTICS LLC will be held harmless in the event of any and all claims. LIMITED POWER OF ATTORNEY FORM LIMITED POWER OF ATTORNEY FORM – BE IT KNOWN, that * with an MC or DOT number of * has made and appointed, and by these presents does make and appoint Warena Johnson/EZN OUT LOGISTICS LLC, 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 Warena Johnson/EZN OUT LOGISTICS LLC dispatch company, 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 virtuethereof. 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: dispatch@eznoutlogisticsllc.com CARRIER/TRUCKING COMPANY NAME * Signature * Printed Name * Title * Date * WITNESS-Notary Printed Name * Title * Date * The Fee for Dispatching Services will be 10% per load. The Fee for Dispatching Services will be 10% per load. As Loads/Freight/Cargo are picked up, delivered, and Carrier/Trucking Company is paid FIRST, an amount equal to the above-stated percentage/pricing scheme will be invoiced, to include set up with Factoring Companies and dedicated lanes are payable to billing@eznoutlogistics.com, or 224-231-8000 via, Zelle or Cash App. Carrier/Trucking Company Phone Number: * Carrier/Trucking Company Email: * Either party has the right to end this agreement without cause at any time giving a seven (7) days’ notice by written request, without penalty. By signing below, I fully understand the terms of this agreement. Carrier/Trucking Company: * Carrier/Trucking Company Signature: * Date * Carrier/Trucking Company/Print Name * Warena Johnson, Manager * Submit CARRIER PROFILE CARRIER PROFILE – Instructions: Please complete this form giving us all the information that pertains to you and your Company. The better informed we are the better we will be able to assist you. This form should 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 SECTION Company * DBA (If Any) Physical Address * City, State, Zip * Mailing Address * City, State, Zip * Main Contact Email * Office Phone Fax Number Cell Phone * Emergency Contact * Emergency Phone * MC Number * DOT Number * EIN Number * SCAC Code TWIC Certified Hazmat Certified PART 2: EQUIPMENT SECTION NUMBER OF TRUCKS COMPANY * OWNER-OPERATORS * NUMBER OF TEAMS NUMBER OF TRAILERS: Van Reefer Flatbed Other Types TRAILER SIZES: Van Reefers/Refrigerated Flatbed DETAILED DESCRIPTION OF EQUIPMENT (I.E. PALLETS, TARPS, OVERSIZE, AND WEIGHT LIMITS): Message PART 3: SERVICE AREAS OF OPERATION DISPATCH SPECIFICATIONS Please give us your minimum cents per mile information. We understand that many factors will change this information, but this will give us a starting point. CENTS ($) PER MILE: MAX PICKS/PICKUPS: MAX DELIVERIES: DRIVER TOUCH (Y/N): : Mountains? (Y/N ) TOLLS? (Y/N) Weight Limit Please select at least one checkbox.Areas of USA you like to travel (ZONES) – Please circle/check all that apply United States Checkbox * Anywhere AL AR AZ CA CO CT DE FL GA IA ID IL IN KS KY LA MA MD ME MI MO MN MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Canada (list provinces) Mexico SECTION 1 – TRUCK OPERATION FORM Truck # * Trailer # * Trailer Type * Max Weight * Driver Name * Driver Cell * Section 2 Truck # Trailer # Trailer Type Max Weight Driver Name Driver Cell 1. Does the assigned driver have the right to make load decisions for you? * 2. Does the driver need to have a copy of the load confirmation? Please keep a blank copy of this form, and email updates to us when they occur, this way we have the most current information on hand. Additional Trucks: Message Submit
