CARRIER INFORMATION

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CARRIER INFORMATIONPlease return the following: Company profile/contact INFORMATION Signed and initialed (each page) contract insurance certificate with USL listed as holder (USL, Box 14309, Cincinnati, OH 45250) Signed/completed W9 Copy of your certificate of authority Copy of a voided check (for direct deposit only)Send all required documents to: or use our online portal at: Box 14309, Cincinnati, OH 45250 Third Bank 38 Fountain Square Plaza, Cincinnati, OH 45263 | Duns: 82-601-9254 | Fed ID: 26-1768346US Logistics Dispatcher you re working with: _____________________________________ CARRIER InformationCOMPANY INFORMATIONCompany NameStreet AddressCity/State/ZipDOT#MC#Smartway Certified?DISPATCHER INFORMATIONContact NameEmailPhoneACCOUNTING INFORMATIONContact NameEmailPhonePAYMENT AUTHORIZATIONPlease check box to choose one option below:n QUICK PAY 1 DAY5% deduction by comchek only (see instructions to the right)Our 1 day pay term requires a 24 hour, business day processing time.

Insurance certificate with USL listed as holder (USL, P.O. Box 14309, Cincinnati, OH 45250) ... 1.2 “Customer” is any business entity or individual which is the owner of cargo, property or other items ... specifically agrees that no released value classification or limitation of liability shall be applicable to any

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