Carrier Enrollment Checklist:
In order to complete our files and process any invoices we receive, we require the following information:
_______X_________ Signed Broker-Carrier Agreement (with middle pages initialed)
_______X_________ Current Insurance Certificate (must have $1mil Auto & $100k Cargo coverage)
_______X_________ Copy of Operating Authority
_______X_________ Copy of DOT Safety Rating Letter (note that if your rating is conditional, we require
a copy of the letter received from the DOT regarding the compliance issues that
led to the conditional rating and a copy of the response sent back to the DOT
addressing the compliance issues and indicating how future issues will be
_______X_________ Carrier Profile
_______X_________ Federal ID Number (W-9) Form
The following forms are optional:
_________________ Quick Pay Form
_________________ Direct Deposit Form
Attached you will find the necessary forms to complete. All pages marked above should be filled out and
returned in order to complete the setup process.
10/29/2008 – v1
MOTOR CARRIER AGREEMENT
This Agreement is entered into this _____ day of_________________, 20____, by and between
Freightquote.com, Inc., a Registered Property Broker (MC-356154), and its subsidiary companies, including Twin
Modal, Inc. a Registered Property Broker (MC-166151), and Rockwell Transportation Services, LLC, a Registered
Property Broker (MC-168132), (collectively hereinafter, “COMPANY”) and ______________________________,
a Registered Motor Carrier, Permit/Certificate No. DOT-___________and MC-____________ (hereinafter,
"CARRIER"). COMPANY and CARRIER collectively shall be referred to hereinafter as the "PARTIES”.
("Registered" means operated under authority issued by the Federal Motor Carrier Safety Administration (or its
predecessors) within the U.S. Department of Transportation).
1. CARRIER REPRESENTS AND WARRANTS THAT IT:
A. Is a Registered Motor Carrier of Property authorized to provide transportation of property under contracts
with shippers and receivers and/or brokers of general commodities;
B. Shall transport the property, under its own operating authority and subject to the terms of this Agreement;
C. Makes the representations herein for the purpose of inducing COMPANY to enter into this Agreement;
D. Agrees that a Shipper’s insertion of COMPANY’s name as the carrier on a bill of lading shall be for the
Shipper’s convenience only and shall not change COMPANY’s status as a property broker nor CARRIER’s
status as a motor carrier.
E. Will not re-broker, assign or interline the shipments hereunder, without prior written consent of
COMPANY. If CARRIER breaches this provision, COMPANY shall have the right of paying the
monies it owes CARRIER directly to the delivering carrier, in lieu of payment to CARRIER. Upon
COMPANY’s payment to delivering carrier, CARRIER shall not be released from any liability to
COMPANY. CARRIER assumes all risk of loss and shall defend, indemnify and hold COMPANY,
its customer, harmless from any liability arising out of violation of the terms of this paragraph
including consequential damages, costs, expenses and reasonable attorney fees.
F. Is in, and shall maintain compliance during the term of this Agreement, with all applicable federal, state and
local laws relating to the provision of its services including, but not limited to: training of drivers,
transportation of Hazardous Materials, (including the licensing and training of Haz Mat qualified drivers), as
defined in 49 C.F.R. §172.800, §173, and §397 et seq. to the extent that any shipments hereunder constitute
Hazardous Materials; security regulations; owner/operator lease regulations; loading and securement of
freight regulations; implementation and maintenance of driver safety regulations including, but not limited
to, hiring, controlled substances, and hours of service regulations; sanitation, temperature, and
contamination requirements for transporting food, perishable, and other products, qualification and licensing
and training of drivers; implementation and maintenance of equipment safety regulations; maintenance and
control of the means and method of transportation including, but not limited to, performance of its drivers;
all applicable insurance laws and regulations including but not limited to workers compensation.
G. CARRIER will notify COMPANY immediately if its federal Operating Authority is revoked, suspended or
rendered inactive for any reason; and/or if it is sold, or if there is a change in control of ownership, and/or
10/29/2008 – v1 1 Initials ______
any insurance required hereunder is threatened to be or is terminated, cancelled, suspended, or revoked for
H. CARRIER shall defend, indemnify and hold COMPANY and its shipper/customer harmless from any
claims, actions or damages, arising out of its performance under this Agreement, including cargo loss and
damage, theft, delay, damage to property, personal injury or death, or violation of any hazardous materials
laws or regulations. CARRIER shall not be liable for any claims, actions or damages due to the negligence
of COMPANY or the shipper. The obligation to defend shall include all costs of defense as they accrue.
I. Does not have an “Unsatisfactory” safety rating issued by the Federal Motor Carrier Safety Administration
(FMCSA), U.S. Department of Transportation, and will notify COMPANY in writing immediately if its
safety rating is changed to “Unsatisfactory” or “Conditional”. If a “Conditional” safety rating is assigned to
CARRIER, CARRIER shall provide COMPANY with written explanation of the reason for the
“Conditional” rating and what action CARRIER has taken to correct it.
J. Authorizes COMPANY to invoice CARRIER’s freight charges to shipper, consignee, or third parties
responsible for payment.
K. Has investigated, monitors, and agrees to conduct business hereunder based on the credit-worthiness of
COMPANY and is granting COMPANY credit terms accordingly.
L. Has authorized the person signing this Agreement to do so.
2. COMPANY RESPONSIBILITIES:
A. SHIPMENTS, BILLING & RATES: COMPANY agrees to solicit and obtain freight transportation
business for CARRIER to the mutual benefit of CARRIER and COMPANY. COMPANY shall inform
CARRIER of (a) place of origin and destination of all shipments; and (b) if applicable, any special shipping
instructions or special equipment requirements, of which COMPANY has been timely notified.
B. COMPANY agrees to conduct all billing services to shippers. CARRIER shall invoice COMPANY for its
(CARRIER’s) charges, as mutually agreed in writing, by fax, or by electronic means, contained in
COMPANY’s Load Confirmation Sheet(s) incorporated herein by this reference. Additional rates for
truckload or LTL shipments, or modifications or amendments of the above rates, or additional rates, may be
established to meet changing market conditions, shipper requirements, COMPANY requirements, and/or
specific shipping schedules as mutually agreed upon, and shall be confirmed in writing (or by fax) by both
Parties. Any such additional, modified, or amended rates, changes in rates shall automatically be
incorporated herein by this reference.
C. RATES: Additionally, any rates, which may be verbally agreed upon, shall be deemed confirmed in writing
where CARRIER has billed the agreed rate and COMPANY has paid it. All written confirmations of rates,
including confirmations by billing and payment, shall be incorporated herein by this reference. Rates or
charges, including but not limited to stop-offs, detention, loading or unloading, fuel surcharges, or other
accessorial charges, released rates or values, or tariff rules or circulars, shall only be valid when specifically
identified and agreed to in a signed writing by the Parties or if CARRIER receives a unique accessorial
authorization code from COMPANY.
i. The Parties agree that COMPANY is the sole party responsible for payment of CARRIER's charges
and under no circumstances shall CARRIER seek payment from COMPANY’s customer, the shipper
or consignee. Failure of COMPANY to collect payment from its customer shall not exonerate
COMPANY of its obligation to pay CARRIER. COMPANY agrees to pay CARRIER's invoice within
thirty (30) days of receipt of the invoice and signed proof of delivery, provided CARRIER is not in
default under the terms of this Agreement.
ii. Payment and other disputes are subject to the terms of Par 4.D, which provides in part that prevailing
parties are entitled to recovery of costs, expenses and reasonable attorney fees.
iii. The PARTIES further agree that CARRIER shall not submit invoices for transportation services more
than 180 (one hundred and eighty) days after the delivery date and CARRIER expressly waives any
right to, or claim for, payment for such transportation charges.
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E. BOND: COMPANY shall maintain a surety bond/trust fund that is on file with the Federal Motor Carrier
Safety Administration (FMCSA) in the form and amount not less than that required by that agency’s
F. COMPANY will notify CARRIER immediately if its federal Operating Authority is revoked, suspended or
rendered inactive for any reason; and/or if it is sold, or if there is a change in control of ownership, and/or
any insurance required hereunder is threatened to be or is terminated, cancelled, suspended, or revoked for
G. NO LIEN: Except when delivery of freight is rejected by the consignee, due to no fault of CARRIER, and
stored/warehoused at the direction of COMPANY or the shipper, CARRIER shall have no lien rights
against freight transported under the Agreement. Liens for storage or warehousing shall be limited to the
freight subject of the lien. CARRIER’s lien rights shall be released and automatically assigned to
COMPANY upon receipt by CARRIER or the storage/warehouse operator of payment for such storage or
H. Broker’s responsibility is limited to arranging for, but not actually performing, transportation of a shipper’s
3. CARRIER RESPONSIBILITIES:
A. EQUIPMENT: Subject to its representations and warranties in Paragraph 1 above, CARRIER agrees to
provide the necessary equipment and qualified personnel for completion of the transportation services
required for COMPANY and/or its customers. CARRIER will not supply equipment that has been used to
transport hazardous wastes, solid or liquid, regardless of whether they meet the definition in 40 C.F.R.
§261.1 et. seq. CARRIER agrees that all shipments will be transported and delivered with reasonable
dispatch, or as otherwise agreed in writing.
B. BILLS OF LADING: CARRIER shall issue a bill of lading in compliance with 49 U.S.C. §80101 et seq.,
49 C.F.R. §373.101 (and any amendments thereto), for the property it receives for transportation under this
Agreement. Unless otherwise agreed in writing, CARRIER shall become fully responsible/liable for the
freight when it takes/receives possession thereof, and the trailer loading is completed, regardless of whether
a bill of lading has been issued, and/or signed, and/or delivered to CARRIER, and which
responsibility/liability shall continue until delivery of the shipment to the consignee and the consignee signs
the bill of lading or delivery receipt. Any terms of the bill of lading (including but not limited to payment
terms, released rates or released value) inconsistent with the terms of this Agreement shall be ineffective.
Failure to issue a bill of lading, or sign a bill of lading acknowledging receipt of the cargo, by CARRIER,
shall not affect the liability of CARRIER.
C. LOSS & DAMAGE CLAIMS:
i. CARRIER shall comply with 49 C.F.R. §370.1 et seq. and any amendments and/or any other applicable
regulations adopted by the Federal Motor Carrier Safety Administration, U.S. Department of
Transportation, or any applicable state regulatory agency, for processing all loss and damage claims
and salvage which arise out of the discharge of CARRIER’s duties and responsibilities hereunder, and
ii. CARRIER’s liability for any cargo damage, loss, or theft from any cause shall be determined under the
Carmack Amendment, 49 U.S.C. §14706; and
iii. CARRIER’s indemnification liability (Par 1.H) for freight loss and damage claims under this sub par C
(ii) shall include legal fees, the risk of which is expressly assumed by CARRIER, and which shall not
be limited by any liability of CARRIER under sub par (ii) above.
iv. Except as provided in Par 1.E above and 3.C.(viii) below, neither Party shall be liable to the other for
consequential damages without prior written notification of the risk of loss and its approximate
financial amount, and agreement to assume such responsibility in writing.
v. Notwithstanding the terms of 49 CFR 370.9,CARRIER shall pay, decline or make settlement offer in
writing on all cargo loss or damage claims within one hundred twenty (120) days of receipt of the
claim. Failure of CARRIER to pay, decline or offer settlement within this one hundred twenty (120)
day period shall be deemed admission by CARRIER of full liability for the amount claimed and a
material breach of this Agreement.
10/29/2008 – v1 3 Initials ______
vi. Unless otherwise agreed to in writing, CARRIER’s liability for any cargo damage, loss, or theft shall
not be limited based on any tariff, rule, circular, or regulation found outside of this Agreement.
vii. In the event COMPANY receives a claim or notation for loss, damage or delay to any shipment
tendered to CARRIER under this Agreement, COMPANY may withhold payment to CARRIER up to
the amount of the claim until the claim is resolved.
viii. COMPANY and CARRIER may agree to specific required pick-up and delivery dates and times for
specific shipments. Such agreements may make the transit time obligation more or less dispatch time.
The Parties acknowledge that time is of the essence in the transportation of cargo under this Agreement
and that monetary damages may accrue if the goods are not delivered within the time frame(s) specified
in COMPANY’s written load confirmation, bill of lading or other shipping directives. If CARRIER
fails to deliver the goods within the time specified in this Agreement, or any written extension given by
COMPANY, CARRIER shall pay actual, consequential, and indirect damages to COMPANY for such
failure to perform in accordance with the Agreement. Such damages may be deducted and retained out
of monies otherwise due CARRIER.
D. INSURANCE: CARRIER shall furnish COMPANY with Certificate(s) of Insurance, or insurance policies
providing thirty (30) days advance written notice of cancellation or termination, and unless otherwise
agreed, subject to the following minimum limits:
Auto Liability - $1,000,000 (One Million Dollars) including hire and non-owned vehicles,
property damage and personal injury liability ($5,000,000 if transporting hazardous materials
including environmental damages due to release or discharge of hazardous substances)
Cargo Liability - $100,000 (One Hundred Thousand Dollars)
Workers Compensation – as required by law.
Except for the higher coverage limits which may be specified above, the insurance policies shall comply
with minimum requirements of the Federal Motor Carrier Safety Administration and any other applicable
regulatory state agency. Nothing in this Agreement shall be construed to limit or avoid CARRIERS’s
liability due to any exclusion or deductible in any insurance policy. The Parties agree that any insurance
certificates furnished by CARRIER to COMPANY, whether designated “sample” or otherwise, shall
constitute representation by CARRIER that CARRIER complies with the insurance requirements set forth
in this Agreement.
E. ASSIGNMENT OF RIGHTS: CARRIER automatically assigns to COMPANY all its rights to collect
freight charges from Shipper, consignee, or any responsible third party on receipt of payment from
A. INDEPENDENT CONTRACTOR: It is understood and agreed that the relationship between
COMPANY and CARRIER is that of independent contractor and that no employer/employee relationship
exists, or is intended. COMPANY has no control of any kind over CARRIER, including but not limited to
routing of freight, and nothing contained herein shall be construed to be inconsistent with this provision.
B. NON-EXCLUSIVE AGREEMENT: CARRIER and COMPANY acknowledge and agree that this contract
does not bind the respective Parties to exclusive services to each other. Either party may enter into similar
agreements with other carriers, brokers, or freight forwarders.
C. WAIVER OF PROVISIONS:
i. Failure of either Party to enforce a breach or waiver of any provision or term of this Agreement shall
not be deemed to constitute a waiver of any subsequent failure or breach, and shall not affect or limit
the right of either Party to thereafter enforce such a term or provision.
ii. This Agreement is for specified services pursuant to 49 U.S.C. §14101(b). To the extent that terms and
conditions herein are inconsistent with Part (b), Subtitle IV, of Title 49 U.S.C. (ICC Termination Act of
1995), the Parties expressly waive any or all rights and remedies they may have under the Act.
D. DISPUTES: This Agreement in all respects shall be governed by, construed and enforced in accordance
with the laws of the State of Kansas, without regard to its conflict of law rules. Each of the Parties hereto
irrevocably and unconditionally submits itself to the exclusive jurisdiction and venue of the state and federal
10/29/2008 – v1 4 Initials ______
courts serving Lenexa, Kansas and any appellate court thereof, in any suit, action or proceeding arising out
of or relating to this Agreement and further irrevocably and unconditionally waives any claim or defense
that any such suit, action or proceeding brought in any such court has been brought in an inconvenient
forum. Each Party further Agrees that a final judgment in any such suit, action or proceeding shall be
conclusive and may be enforced in other jurisdictions in any manner provided by law. Broker shall be
entitled to recovery of reasonable attorney’s fees incurred to enforce the terms of this Agreement.
E. NO BACK SOLICITATION:
i. CARRIER shall not solicit freight shipments from any shipper, consignor or consignee or other
customer of COMPANY when: (a) the availability of such shipments first became known to CARRIER
as a result of COMPANY’s efforts; or (b) where such shipments of the shipper, consignor or consignee
or COMPANY customer were first tendered to CARRIER by COMPANY. Transportation of freight
hereunder by CARRIER shall be deemed conclusive evidence of CARRIER’s solicitation and
performance of transportation service to COMPANY’s customer.
ii. In the event of breach of this provision, COMPANY shall be entitled, for a period of eighteen (18)
months following delivery of the last shipment transported by CARRIER under this Agreement, to a
commission of twenty percent (20%) of the transportation revenue (as evidenced by freight invoices)
received by CARRIER for the transportation of said freight as liquidated damages. Additionally,
COMPANY may seek injunctive relief and in the event it is successful in obtaining such injunctive
relief, CARRIER shall be liable for all costs and expenses incurred by COMPANY related thereto,
including, but not limited to, reasonable attorney’s fees.
i. During the term of this Agreement and for three (3) years after termination for any reason, the
CARRIER shall not directly or indirectly disclose to anyone, or use for its own, or anyone else’s
benefit, Confidential Information as defined herein. Under this Agreement, “Confidential Information"
shall mean information of the COMPANY which includes (but is not limited to) business and/or
marketing and sales plans, trade secrets, customer names, customer contacts, personal customer
information, customer shipping or other logistics requirements, billing amounts for any shipments
handled by CARRIER under this Agreement, and all pricing information related to COMPANY, and
COMPANY’s customers. “Customer”, for purposes of this Agreement, shall mean any person or entity
with whom COMPANY is or has conducted business during the 18 months immediately preceding
violation of this Agreement and who was introduced to CARRIER by COMPANY. Confidential
Information may be disclosed either orally, visually or in tangible form (whether by document,
electronic media, or other form). The failure of either Party to mark, label or identify any of the above-
described information as Confidential shall not affect its status as part of the Confidential Information
protected by this Agreement.
ii. In the event of violation of this paragraph and/or 4E, CARRIER acknowledges and agrees that the
remedy at law, including monetary damages, may be inadequate and that COMPANY shall be entitled,
in addition to any other remedy it may have, to an injunction restraining CARRIER from violation of
this Agreement in which case CARRIER shall be liable for all costs and expenses incurred by
COMPANY related thereto, including but not limited to reasonable attorney’s fees.
G. FOREIGN SHIPMENT LIABILITY: The limitations of liability for cargo loss and damage as well as other
liabilities, arising out of the transportation of shipments, which originate outside of, and are destined for, the
United States of America, may be subject to the laws of the country of origination.
H. MODIFICATION OF AGREEMENT: This Agreement and Exhibit A, et.seq. attached may not be
amended, except by mutual written agreement, or the procedures set forth above (Pars 2.B and 2.C).
i. All notices provided or required by this Agreement, shall be made in writing and delivered, return
receipt requested, to the addresses shown herein with postage prepaid; or by confirmed (electronically
acknowledged on paper) fax; by courier upon receipt of delivery; or by e-mail with electronic receipt.
ii. The Parties shall promptly notify each other of any claim that is asserted against either of them by
anyone arising out of the Parties performance of this Agreement.
10/29/2008 – v1 5 Initials ______
iii. Notices sent as required hereunder, to the addresses shown in this Agreement shall be deemed sent to
the correct address, unless the Parties are notified in writing of any changes in address.
J. CONTRACT TERM: The term of this Agreement shall be one year from the date hereof and thereafter it
shall automatically be renewed for successive one (1) year periods, unless terminated, upon thirty (30) day's
prior written notice, with or without cause, by either Party at any time, including the initial term. In the
event of termination of this Agreement for any reason, the Parties shall be obligated to complete
performance of any work in progress in accordance with the terms of this Agreement.
K. SEVERANCE: SURVIVAL: In the event any of the terms of this Agreement are determined to be invalid
or unenforceable, no other terms shall be affected and the unaffected terms shall remain valid and
enforceable as written. The representations, rights and obligations of the Parties hereunder shall survive
termination of this Agreement for any reason.
L. COUNTERPARTS: This Agreement may be executed in any number of counterparts each of which shall
be deemed to be a duplicate original hereof.
M. FAX CONSENT: The Parties to this Agreement are authorized to fax to each other at the numbers shown
herein, (or otherwise modified in writing from time to time) shipment availabilities, equipment and rate
promotions, or any advertisements of new services.
N. ENTIRE AGREEMENT: Except for Exhibit A and its amendments, and unless otherwise agreed in writing,
this Agreement contains the entire understanding of the Parties and supersedes all verbal or written prior
agreements, arrangements, and understandings of the Parties relating to the subject matter stated herein.
The Parties further intend that this Agreement constitutes the complete and exclusive statement of its terms,
and that no extrinsic evidence may be introduced to reform this Agreement in any judicial or arbitration
proceeding involving this Agreement.
IN WITNESS WHEREOF, we have signed this Agreement the date and year first shown above.
Printed Name : Tom Kmak Printed Name:
Title: President / COO Title:
Company Address: Lenexa, KS 66219 Company Address:
Phone: 866 318 4377 Phone:
Fax: 913 319 0638 Fax:
10/29/2008 – v1 6
ALL FIELDS ARE REQUIRED
Please send copies of: (1) Your Operating Authority, (2) Proof of Cargo and Liability Insurance, (3) Your Federal ID Number, (4)
MSC-90 Endorsement (Haz Mat Carriers Only), (5) DOT Safety Rating Number and answer the following brief questions:
***PLEASE PRINT ALL INFORMATION CLEARLY***
Company Name: ____________________________________________________________________________________________
Federal ID#: __________________________ MC#:____________________________DOT#_______________________________
Mailing Address: ____________________________________________________________________________________________
City: ___________________________________________________ State _______________ Zip ___________________________
Phone: ____________________________________________Toll-Free: _______________________________________________
Fax: ____________________________________ Email: ____________________________________________________________
Can POD’s be printed from this sight ___________YES______________NO
Payment Remit Address: _____________________________________________________________________________________
Send Checks Payable To (if different than carrier name): ____________________________________________________________
IMPORTANT NOTE: YOUR INVOICE MUST REFERENCE JOB/BOL NUMBER FOR PAYMENT
Type of Business: ____ Corporation ____ Partnership ____ Sole Proprietor ____ Other: _________________________________
EQUIPMENT (Please enter the approximate NUMBER AND TYPE for each unit. ): (Example 5 Vans)
Vans: ____Vans ____Air ride vans ____Hi cube (110” vans ____ Logistic vans ____ Padded vans ____ Curtain vans
Flats: ____ Flatbeds ____ Stepdecks ____ Double drops ____ Removable goosenecks ____ Hot shots ____ Side kits
Reefers: ____ Chilled & frozen ____ Chilled only ____ Fozen only
Power Units: ____
DOES YOUR COMPANY OFFER ANY OF THE FOLLOWING? (Answer as appropriate):
Brokerage Service: ____ Yes ____ No U.S. Customs Bond: ____ Yes ____ No (If yes, Bond # ___________)
If yes, please attach copy of SURETY BOND
Ground Expedite Service: ____ Yes ____ No Air Expedite Service: ____ Yes ____ No
Liftgate Service: ____ Yes ____ No Partial Truckload Service: ____ Yes ____ No
Team Drivers: ____ Yes ____ No Tow Away (Tractor-Only) Service: ____ Yes ____ No
HazMat Service: ____ Yes ____ No
10/29/2008 – v1
10/29/2008 – v1
Twin Modal Quick Pay Program (OPTIONAL)
If you would like to be setup as a quick pay carrier, please review the guidelines listed below, check the appropriate box
indicating the preferred method of payment, and then fill out the required information for the applicable payment method.
• The cost of the quick pay service is a 2% discount (effective through 1/1/09**) that will be taken from the
agreed upon rate for each shipment.
• Fax or e-mail a copy of the invoice, a clear proof of delivery, and any additional documentation (weight ticket,
lumper receipt etc.) to 651-746-3792 or firstname.lastname@example.org
• Twin Modal will remit payment within 48 hours with a clear proof of delivery
• If we receive an invoice billed at an incorrect rate or if the applicable shipment has damage/loss noted (or some
other service issue), then we will work expeditiously to resolve and allow the carrier to determine whether they
would still like quick pay service after the issue is resolved. Otherwise, the invoice will be paid at standard 21-day
• Shipments booked with Twin Modal prior to returning this signed form will be paid based on standard 21-
• Note that your company will remain on quick pay for any and all invoices submitted for payment until a written
notice to cancel the quick pay program is received.
Direct Deposit (please fill out the enclosed direct deposit form)
Comcheck (Comcheck fee will be deducted)
Company Name: ____________________________________________________________________
Remit to Address: ___________________________________________________________________
City, State/Province, Zip/Postal Code: ___________________________________________________
MC Number: ____________________________________________________________________
Accounts Receivable Contact Name: _____________________________________________________
Accounts Receivable Contact Phone #: ___________________________________________________
By signing below, you acknowledge that all payment information provided is accurate and agree to the guidelines
Authorized Signature: ________________________________________________________________
Printed Name: ______________________________________________________________________
**subject to change with 30 days written notice
10/29/2008 – v1
Twin Modal, INC.
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT (OPTIONAL)
Company Name MC #
I (we) hereby authorize Twin Modal, hereafter called CORPORATION, to initiate credit entries to my (our)
Checking Savings account (select one) indicated below and the depository named below, hereafter called BANK, to
credit the same to such account.
BANK NAME: __________________________________________
BANK ADDRESS: Street: ________________________________________________________________
City: _____________________________ State: ____________ Zip Code: __________
TRANSIT / ABA NO._________________________________________________
This authority is to remain in full force and effect until CORPORATION has received written notification from me (or either
of us) of its termination in such time and in such manner as to afford CORPORATION and BANK a reasonable
opportunity to act on it.
Signature(s) (Owner or Corporate Officer)
Remittance Advice Delivery: FAX to_____________________ or email to _________________________
IMPORTANT! CHECK TYPE OF ACCOUNT: [ ] CHECKING [ ] SAVINGS
ATTACH YOUR VOIDED CHECK HERE
Fax this completed form along with the above copy of your company’s voided check (not a deposit slip) to 913-
319-0638. If any of the above information changes, you will need to resubmit this completed form. Thank you.
10/29/2008 – v1
Credit & Contact Information
We are pleased to provide the following information about our company to assist you in doing business with us.
Twin Modal, Inc. is an I.C.C.-Licensed Property Broker (MC-166151) and Intermodal Marketing Company. Twin
Modal has been in business since 1977.
Atlanta, GA Hartford, CT Missoula, MT
Phone: 770-974-3806 Phone: 860-290-8764 Phone: 406-542-3686
Fax: 770-974-8879 Fax: 860-290-8797 Fax: 406-542-6697
Chicago, IL Intermodal Services, MN Sioux Falls, SD
Phone: 651-697-8870 Phone: 651-697-8860 Phone: 605-331-2624
Fax: 312-649-9315 Fax: 651-635-9423 Fax: 605-334-5180
Dallas, TX Minneapolis, MN LTL Services, MN
Phone: 817-607-9772 Phone: 651-697-8840 Phone: 651-697-8828
Fax: 817-640-1809 Fax: 651-697-8899 Fax: 651-697-8894
SURETY BOND: $10,000 through Amtex and $90,000 through Lincoln – Bond # 100006.
FEDERAL ID: #41-1261626
OFFICERS: Robert (Chip) Smith, President; Timothy Barton, CEO
BANK: Bank of America (Account #5800689332)
D & B: # 13-065-0401
Bay & Bay Dart Transit Co. MCU Intermodal SAIA Motor Truck Roadway Express Donnelly Trans.
Rosemount MN Minneapolis MN St. Paul MN Duluth GA Eagan MN Oakbrook IL
651-480-7961 800-366-9000 651-222-2224 800-765-7242 651-905-6246 630-789-9180
651-480-7965 651-681-6422 FAX 651-222-1549 FAX 770-232-4064 FAX 651-681-9400 FAX 630-789-9368 FAX
BILLING ADDRESS: Twin Modal, Inc.
P.O. Box 3780
Olathe, KS 66063
Ph: (866) 318-4375
Fax: (651) 746-3792
Quick Pay Program - 2 % Next Day
ACH Direct Deposit also available
Important Notes: Your invoice must reference Twin Modal's job number for payment. Prior to arranging a load with
your company we require that you provide us with an executed copy of our broker-carrier agreement as well as the
information requested on the enclosed page.
Please call (866) 318-4375 with any questions.