MC: [MC Number]
DOT: [DOT Number] [Carrier Address] [Carrier Phone] | [Carrier Email]
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Confirmation Date: [MM/DD/YYYY] Load / Reference No.: [Load Number]
Status: Agreed Shipment
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Shipment Agreement Notice
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This rate confirmation confirms the agreed shipment between the broker and carrier listed below. The load details, charges, pickup and delivery requirements, and listed terms govern this shipment unless amended in writing by both parties before transit begins.
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Broker Company: [Broker Company Name]
Contact: [Broker Contact Name] Phone: [Broker Phone]
Email: [Broker Email]
Billing Address: [Broker Billing Address]
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Carrier Company: [Carrier Company Name] MC
DOT: [MC Number] / [DOT Number]
Dispatcher: [Dispatcher Name]
Driver: [Driver Name]
Driver Phone: [Driver Phone]
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Load Number: [Load Number]
Equipment Type: [Dry Van / Reefer / Flatbed / Other]
Commodity: [Commodity Description]
Weight: [Total Weight]
Piece / Pallet Count: [Piece Count] / [Pallet Count]
Temperature Requirement: [If Applicable]
PO / Reference Numbers: [PO or Reference Numbers]
Special Handling: [Securement, seal, food-grade, hazmat, or other instructions]
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Shipper: [Shipper Name]
Address: [Pickup Address]
Pickup Date: [MM/DD/YYYY]
Time Window: [Start Time] – [End Time] Appointment No.: [Appointment Number] Contact: [Pickup Contact Name and Phone]
Instructions: [Loading instructions, dock details, PPE, check-in location]
Check-In Requirement: Driver must reference load number [Load Number] and obtain signed BOL before departure.
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Consignee: [Consignee Name]
Address: [Delivery Address]
Delivery Date: [MM/DD/YYYY]
Time Window: [Start Time] – [End Time]
Appointment No.: [Appointment Number]
Contact: [Delivery Contact Name and Phone]
Instructions: [Unloading instructions, gate entry, lumper process, dock details]
Delivery Requirement: Driver must obtain signed POD with printed name, date, and time of delivery.
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Rate and Accessorial Terms
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Line-Haul Rate: $[Amount]
Fuel Surcharge: $[Amount or Included]
Stop-Off Charges: $[Amount or Not Applicable] Detention: $[Amount] after [Free Time] with facility verification
Layover: $[Amount] per approved layover event
TONU: $[Amount] if applicable and approved in writing
Other Accessorials: [List any agreed charges or state None]
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All rates are subject to the terms listed in this confirmation and any written amendments approved by broker and carrier.
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Required Documents and Payment Terms
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- Signed bill of lading must be provided with the invoice.
- Proof of delivery must include receiver signature, printed name, delivery date, and delivery time.
- Invoice and supporting documents must be submitted to [Invoice Email Address].
- Payment terms: [Net 30 / Quick Pay Terms / Other].
- Carrier must maintain required insurance, operating authority, and compliance documentation for the duration of this shipment.
- Any detention, layover, lumper, or additional charge must be approved in writing before billing.
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Confirmation and Acceptance
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By accepting this rate confirmation, broker and carrier acknowledge the shipment details, agreed rate, required documents, and operational terms stated above. Any changes must be confirmed in writing before pickup or before the affected service is performed.
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Broker Authorized Signature: _____________
Date: ________________________________
Carrier Authorized Signature: _____________
Date: ________________________________
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