JEMSTONE TRANSPORT™
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Sign up today to join our network of Auto Transporters.
Motor Carrier-Broker Agreement
w-9 Form
Carrier Request Form
*
Indicates required field
Company Name
*
Tax/EIN#
*
DOT#
*
Drivers License #
*
MC#
*
Insurance Provider
*
Company Address
*
Line 1
Line 2
City
State
Zip Code
Country
Website URL
*
Type Of Hauler:
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2-4 Car Hauler
5-7 Car Hauler
8+ Car Hauler
Disclaimer
*
***JemStone Transport requires all Carriers to use over-the-tire straps for securing and transporting a vehicle. Any damage caused by chains or improper equipment will be charged to the carrier.***
Name of Company Official
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First
Last
Title
*
Contact Email
*
Dispatch Phone Number
*
Fax Number
*
Terms and Conditions
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***I accept the Terms and Conditions in the Carrier/Broker Agreement provided above. I give permission to JemStone Enterprise LLC to be named the Certificate Holder on my insurance policies. I hereby give consent and certify the accuracy of the above information.***
*** Please send a copy of your
W-9
along with a copy of your Certificate of Insurance (Showing the cargo insurance and listing 'JemStone Enterprise LLC/Address: 650 Glenwood Ave, Rochester, NY, 14613' as Certificate Holder) to email :
[email protected]
Submit
Home
About
Become a Carrier
Resources for Carriers
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