SIGN UP FORM — SOUTHWESTERN TRUCKING

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Company Name or D/B/A

Mailing Address

MC # (if you have your own authority)

US DOT # (we can help with this if you don't have it)

EIN (Federal Tax ID) - Critical because we handle your w9 documentation for Shippers

TRUCK (Year-Make-Model-GVWR). If multiple trucks, list each separately

Trailer(s) - TYPE and GVWR

Regional Area of Preference

CURRENT FACTORING COMPANY (If you don't have one, we recommend TAFS)

INSURANCE COMPANY (Company Name, Agent Name, Phone Number)

List 3 References ... We do NOT require references, but it is helpful to us in setting up your broker packs

IF you are not the driver, or if you have multiple drivers, list their names and cell phone numbers

What else should we know?! Tell us about anything you feel is important about your operations... we are here to serve YOU!

I agree to have BIG TRUCK 107 book my loads at the fee rate as shown in the "Dispatch Services" page. I further agree to pay my invoice weekly through paypal or credit/debit card. I give full consent to BIG TRUCK 107 team members to complete and sign documents as required to book loads. I further agree to "Hold Harmless" BIG TRUCK 107, HOT SHOT 107, Dispatch 107, and Black Magic Dispatch.

Please check the Box and Sign Below.

By checking this box, I agree to accept the terms above and I hereby authorize BIG TRUCK 107 as my dispatch agent.

ELECTRONIC SIGNATURE

Type your name to accept this simple agreement ... You are NOT bound to a long term contract.

First Name

Last Name

Referral Code (or Name) - Leave Blank if you don't have a referral source

IMPORTANT NOTE: You MUST Email a copy of your MC Authority (or DOT), a completed w9, and a copy of your Insurance to INFO@Dispatch107.com to complete the set-up process. If you can not scan and email, PLEASE do not send a photo of these documents - the best secondary option is to fax to 585-219-4625. We can NOT book freight without this information.

Welcome to the BIG TRUCK 107 Team! We look forward to working with you! Please be sure to contact us with ANY questions... Remember, we are different from "FREIGHT BROKERS"... they work for the SHIPPER, while we work for YOU! It is their mission to ship as inexpensively as possible, while it is our mission to MAXIMIZE your earnings and keep you on the best routes.

Due to recent scams, we now require 1 week of dispatch fees paid in advance for all new clients. This is a form of deposit, but the fees are not refundable. You will be invoiced weekly for all dispatch work. If you fail to pay an invoice, the fees will be deducted from this pre-paid deposit. We NEVER require any form of long term commitment or exclusive contract, but if you ever decide to leave, your initial pre-paid deposit will simply be used to close out your final week of dispatch. Under certain circumstances, we will consider exceptions on a case-by-case basis. Management decisions are final.

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