Carrier or Trucking Company Name *

Enter your name or name of Trucking Company. Thank you.

Trucking Information *

Please list your MC#, DOT#, Truck# and Trailer#. Thank yo

Where do you live?*

Address

City*

State/Province*

ZIP/Postal Code*

Country*
AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Republic of theCongo, Democratic Republic of theCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe

E-mail*

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Phone

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Terms and Conditions

Carrier hereby grants authorization to Silk Dispatch Services LLC to act as its agent for the sole purpose of searching for and booking loads, processing all brokerage paperwork and obtaining/submitting all necessary documents required in order to expedite loads and dispatch via telephone, fax or e-mail. All billing, invoicing and collections of revenue from customers, brokers, shippers, consignees, etc. - are the sole responsibility of the carrier. If revenue for a shipment or shipments is uncollectible, Silk Dispatch Services LLC will be held harmless and no penalty or deduction of fees will be made. The carrier agrees to maintain all proper licenses and permits to conduct business as a motor carrier in the area of intended operation. Additionally, carrier agrees to maintain general liability and cargo insurance at the amounts set forth by the home state of the carrier. Silk Dispatch Services LLC will be held harmless in the event of any and all claims. As loads are picked up, delivered, and carrier is paid FIRST, an amount equal to the above stated percentage will be payable to: Silk Dispatch Services LLC. Payments to the dispatcher, once carrier is paid, are to be conveniently paid with any Debit or Credit Card. Carrier will be invoiced once they are paid from Broker or factoring company. Either party has the right to end this agreement without cause at any time with seven (7) days’ notice by written request.

Date of Submission *

Consent *

I authorize Silk Dispatch Services LLC to complete all broker Carrier Packets and Rate Confirmations on my behalf

I consent to having the Carrier Packets and Rate Confirmations completed by Silk Dispatch Services LLC on my behalf.

OTHER DOCUMENTS NEEDED

Please upload copies of your W9, MC AUTHORITY LETTER and CERTIFICATE OF INSURANCE. Thank you.

Signature *

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