CARRIER PROFILE

Company Information:

Physical Address

Mailing Address

Contact Information:

Insurance Information

Carrier References

CARRIER PAYMENT TERMS AGREEMENT FORM

PLEASE NOTE:

CARRIER MUST MENTION ON EACH INVOICE WHAT PAY TERMS THEY ARE SEEKING. IF NO QUICK PAY TERMS ARE REQUESTED ON INVOICE THEN THE INVOICE WILL BE PAID AFTER 15 DAYS (REGULAR PAY).

Bank Information:

By signing below, you hereby authorize PDX Freight Logistics, LLC to initiate automatic deposits to my account at the financial institution listed above. You also authorize PDX Freight Logistics, LLC to make withdrawals from your account in the event that a credit is made in error; you agree not to hold PDX Freight Logistics, LLC responsible for any delay or loss of funds due to incorrect or incomplete information supplied by you or by your financial institution or due to an error on the part of your financial institution in depositing funds into your account.

FACTORING

If you have a factoring company, please fill out this section below. If you don’t, please leave it blank.

Required Documents

● Insurance Certificate showing PDX Freight Logistics, LLC as the Certificate Holder
● Signed pages of the Broker/Carrier Agreement
● Completed W9 Form
● MCPermit
⇒ PLEASE READ CAREFULLY BROKER CARRIER TRANSPORTATION AGREEMENT