Becoma a Carrier – Charger Global Logistics Inc

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Company Details

Legal Company Name

DBA (Doing Business As)

MC Number

DOT Number

EIN / Tax ID

Number of Trucks

Number of Drivers

Type of Operation

Carrier
Owner Operator
Fleet Owner

Company Address

City

State

ZIP Code

Contact Information

Name

Title

Phone Number

After Hours Contact

Insurance Details

Insurance Company

Agent Name

Agent Phone

Agent Email

Upload Documents

Operating Authority

W9 Form

Certificate of Insurance (COI)

Voided Check or Factoring NOA (If Applicable)

Compliance Verification

Active FMCSA Authority
No Unsatisfactory Safety Rating
No Out-of-Service Orders
Valid Operating Authority
Current Insurance Coverage
Carrier agrees to comply with all FMCSA regulations.

☐ I certify that all insurance information provided is accurate and current.

Equipment Types

Truck Type:

Dry Van
Reefer
Flatbed
Step Deck
Hotshot
Power Only
Box Truck
Conestoga
Lowboy
RGN
Sprinter Van

Operating States

Alabama
Arizona
Arkansas
California
Colorado
Florida
Georgia
Illinois
Indiana
Kansas
Kentucky
Louisiana
Michigan
Minnesota
Missouri
Nevada
New Jersey
New York
North Carolina
Ohio
Oklahoma
Oregon
Pennsylvania
Tennessee
Texas
Virginia
Washington
Wisconsin

Email Any Voided

Preferred Lane

Factoring Company

Provide The Information Below If you are using Factoring:

We are currently using a factoring company.
We are not currently factoring invoices.

Factoring Company Name

Contact Person

Phone Number

Banking Information

Bank Name

Account Holder Name

Routing Number

Account Number

Safety & Compliance Questionnaire

Have you had any FMCSA violations within the last 24 months?

Any cargo claims within the last 36 months?

Any accidents within the last 36 months?

Dedicated Lane Program Agreement

Dedicated Lane Reservation Agreement.

To ensure lane availability, broker commitment, dispatch resources, compliance monitoring, and carrier support, a one-time Slot Securing Fee of $575 is required before activation of any dedicated lane program.

This fee is not a brokerage fee. It covers:

Dedicated lane reservation
Carrier onboarding and verification
Compliance processing
Dispatch setup
Customer allocation
Lane management support
Broker network integration
Administrative processing

The fee helps prevent lane reservation abuse and ensures that only committed carriers reserve dedicated freight opportunities.

How would you like to Pay Slot Securing Fee? *

Zelle
CashApp
Vinmo
Chime
Apple Pay
ACH

Accept Terms:

I understand and agree that a Slot Securing Fee of $575 is required to reserve dedicated lane opportunities.
I understand that lane availability may change based on customer requirements.
I understand that acceptance into the program does not guarantee load volume.
I agree to comply with all dispatch and customer requirements.

Terms and Conditions

Carrier Agreement Terms

Carrier certifies that all information submitted is accurate.
Carrier maintains all required FMCSA authority and insurance.
Carrier agrees to comply with all federal, state, and local transportation regulations.
Carrier is solely responsible for vehicle maintenance, driver qualifications, and cargo securement.
Carrier shall maintain active insurance throughout participation.
Broker may suspend or terminate participation for compliance violations.
Dedicated lane opportunities are subject to shipper requirements and freight availability.
Payment terms remain subject to each load confirmation agreement.
Carrier agrees not to solicit customers directly introduced through the broker.
Any fraudulent information may result in immediate termination.

I have read and agree to the Terms and Conditions.

Privacy Policy

We collect carrier information for:

Carrier qualification
Compliance verification
Insurance verification
Dispatch operations
Payment processing
Regulatory compliance

Information may be shared with:

Shippers
Brokers
Insurance providers
Factoring companies
Regulatory agencies when required by law

We do not sell carrier information to third parties.

All submitted information is stored securely and used solely for transportation and logistics business purposes.

Privacy Consent

I have read and accept the Privacy Policy.

Authorized Representative

Full Name