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Agreement
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Agreement
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Broker Information
Broker Name:
Usa brokers
Carrier Details:
Carrier Name:
*
USDOT/MC Number:
*
Phone Number:
*
Agreement Date:
*
Select Services With Fees:
*
Dedicated Lane Setup $499 Refundable after first successful load delivery
TWIC Card Application $445 Same-day processing
Insurance Assistance $399 Fast-track insurance quote & setup
Trailer Rental (3 months) $500 Subject to availability
Factoring Setup $420 Same-day registration
Accept terms and conditions
*
I have read and agree to the terms and conditions
Signatory Information
Full Name:
*
Title/Position:
*
Signature:
*
Email
*
Preferred Payment Method for Security Deposit (Refundable)
Select Your Prefered Method
*
Zelle
Cashapp
Venmo
Chime
Bank Transfer
Crypto Payments (ERC 20 & BTC)
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