Application For Services - Consulting, CTC, and Audits


***IMPORTANT:  YOU MUST SCROLL DOWN TO SIGN, THEN HIT "AGREE & SIGN" BUTTON***


APPLICATION FOR SERVICES

Consulting, CTC, and Audits ***ORIGINAL APPLICATION***

Date of Application:  July 22, 2024


GENERAL COMPANY INFORMATION

Business Legal Name or Individual Name:  
DBA:  
Type of Business:  
Address:  
Phone Number:       Fax Number:  
Email Address:    Website:   

Individuals
DOB:
     SS#:     DL#:    State:   

Company
Federal ID#:    Partnership #:     Corporation #:    LLC #:   


PERSON TO CONTACT REGARDING SERVICES

Name:  
Email:  
Phone:  
Fax:   

Preferred method of contact:   


PERMITS

Please list all account numbers for all permits that your company currently holds:

CA # / MCP:   
IFTA#:
 
NM:
 
KY:
 
NY: 
 
OR: 

MC/ICC#: 
 
MC PIN#: 
 
US DOT#: 
 
DOT PIN#: 
 
HAZARDOUS MATERIALS#:
   
REQUESTER CODE#: 
 

If leased to carrier: 
Name:    DOT #:    Fed ID #:   

 


TYPE OF CARRIER

Type of carrier: 

Do you haul:   

 


UNIT AND DRIVER INFORMATION

# of power units:   
# of trailers:   
# of drivers employed by your company:   


PRODUCTS HAULED

 Please list all the products your company hauls:   
Do you haul Hazardous Waste Products?   
If yes, please describe the products:   


INSURANCE

Insurance Company:   
Insurance Agent:   
Insurance Number:   
Insurance Fax:   

Do you have liability coverage?   
Do you have Workers Compensation Insurance?   


SERVICE AGREEMENT

This agreement is made by and between Road Ready Registration Entities, a California Corporation with it principal place of business located at 9561 PITTSBURGH AVE RANCHO CUCAMONGA, CA 91730 and with its principal office located at .

Road Ready Registration Entities provides various Title & Registration Services, Renewals, Interstate Commercial Licensing, Permits, Fuel Tax Reporting, Authority Filings, and DOT Drug & Alcohol Services.

Now, therefore, for good and valuable consideration, the parties agree and follow:

  1. Article 1 (Term) – This Agreement will become effective on the date on which it is signed by a representative of the Company and the Title & Registration Services, Renewals, Interstate Commercial Licensing, Permits, Fuel Tax Reporting, Authority Filings, and DOT Drug & Alcohol Services has been completed by the Customer. This agreement shall remain in effect for one (1) year.
  2. Article 2 (Services) – Subject to qualifying, Road Ready Registration Entities shall provide the Customer Title & Registration Services, Renewals, Interstate Commercial Licensing, Permits, Fuel Tax Reporting, Authority Filings, and DOT Drug & Alcohol Services at the rate of agreed upon price sheet, (please see attached price sheet).
  3. Article 3 (Indemnification) – Road Ready Registration Entities is an independent contractor providing the Customer with Title & Registration Services, Renewals, Interstate Commercial Licensing, Permits, Fuel Tax Reporting, Authority Filings, and DOT Drug & Alcohol Services provided herein. The Customer agrees to indemnify, defend and hold Road Ready Registration, Inc., its officers, directors, agents, employees and other related parties harmless from and against any and all liabilities, damages, losses, expenses, claims, demands, suits, fines, or judgments that include reasonable attorney’s fees, costs and expenses, incidentals thereto, which may cause suffrage or may come into existence as a claim that is legally enforceable and may accrue for charges to or recoverable from any customer or customers’ client indemnitee, by reason of any claim arising out of or relating to any act or error or omission, or misconduct of Road Ready Registration Entities, its officers, directors, agents, employees or subcontractors.
  4. Article 4 (Force Majeure) –Road Ready Registration Entities will not be responsible or liable to the Customer for failure or delay in performance, which results from or is due to, directly or indirectly and in whole or part, any cause or circumstances beyond the reasonable control of Road Ready Registration Entities.
  5. Article 5 (Payment Terms) –Payment is due upon receipt of services, unless other arrangements have been made in writing. Every 30 days a letter will be generated for late payments. Any open balances over 90 days late will be subject to collection through Road Ready Registration Entities collection agency.
  6. Article 6 (Fixed Pricing) –No increase or decrease of fees will be automatic. A minimum of 30 days written notice is required. Road Ready Registration Entities is not responsible for any oral instructions.
  7. Article 7 (Applicable Law) – This Contract will be construed under the laws of the State of California.
  8. Article 8 (Termination and Renewal of Agreement) – If this Agreement is suspended or terminated for any reason by the Customer, the money received shall be deemed earned. It is understood by all parties and it’s employees that this agreement shall remain in effect until cancelled by either party, with a thirty (30) days written notice.
  9. Article 9 (Cancellation) – If the account is 90 days or older Road Ready Registration Entities can choose to cancel your account, until your account is brought current.
  10. Article 10 (Terms and Conditions) –The only terms and conditions that will be applicable to the interpretation of this agreement are those issued by Road Ready Registration Entities, of Rancho Cucamonga, California.

 

Your digital signature of this Service Agreement below indicates your acceptance of the Terms and Conditions.

 


*** OFFICE USE ONLY ***
Date Received: _________________________________________   Rep: ___________________________________________________
Customer Folder Type:    Brown    Manilla      Purple      Green
Copies Given To:   _______  Office Manager      _______ Accounting
 Power of Attorney Received Date: ___________________________________________________
 Service Fee Price Sheet Received Date: ___________________________________________________
 Service Agreement Received Date: ___________________________________________________


 

***IMPORTANT:  YOU MUST SIGN BELOW, THEN HIT "AGREE & SIGN" BUTTON IN BLUE CORNER***

YOUR SUBMISSION WILL NOT BE DIGITALLY SIGNED UNLESS THIS IS COMPLETED

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Signature Certificate
Document name: Application For Services - Consulting, CTC, and Audits
lock iconUnique Document ID: ec7a66bb26a3034f4031e5c1d92af23a7631e468
Timestamp Audit
June 26, 2024 10:00 pm PDTApplication For Services - Consulting, CTC, and Audits Uploaded by Natalie Banks - managers@roadreadyreg.com IP 68.111.90.210
June 27, 2024 11:55 pm PDTRoad Ready Managers - managers@roadreadyreg.com added by Natalie Banks - managers@roadreadyreg.com as a CC'd Recipient Ip: 68.111.90.210