Lee Truck Broker

 Phone: (870) 673‐6921 Watts: (800) 736‐7533 Fax: (870) 673‐7980 Date of incorporation is April 1984 Billing & remit to address: P.O. Box 628 Stuttgart, AR 72160 Physical address: 2302 South Main Street Stuttgart, AR 72160 Bank: Farmers & Merchants Bank (870) 673‐6911 Officer: Charlie Holt President/ Owner: Randy Lee After hours: (870) 672‐2010 Sales & Dispatch: Grant Lee After hours: (870) 672‐2149 Brandon Lee After hours: (501) 516‐2514 Derrick McCarley After hours: (870) 672‐2472 Martha Sells After hours: (870) 672‐2787 Eric Nutt After hours: (870) 403‐2302 Receivables & Payables Sarah Shelton Susan Hale Laurie Hoffpauir Federal ID# 71‐0594700 MC# 177190 SCAC: LTBN [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] LEE TRUCK BROKER, INC.
800‐736‐7533
FAX 870‐673‐7980
FOR OFFICE USE ONLY
CODE:
DATE:
COMPANY NAME:
CONTACT:
PHYSICAL ADDRESS:
REMIT ADDRESS:
WATTS#
FAX #
OFFICE #
AFTER HOURS#
EMAIL:
TYPE: CHECK ONE
INDIVIDUAL SSN #
CORPORATION FEIN #
PARTNERSHIP FEIN #
TYPE OF AUTHORITY: COMMON
MC#
US DOT#
CONTRACT
BROKER
EQUPMENT: CHECK ALL THAT APPLY
53' REEFER
TANK
48' REEFER
AIR RIDE
53' VAN
HOT SHOT
48' VAN
STEP DECK
53' FLAT
HOPPER
48' FLAT
REFERENCES:
1
PHONE
2
PHONE
THIS SHEET MUST BE FILLED OUT COMPLETLY BEFORE WE WILL SET YOU UP.
Lee Truck Broker, Inc.
P.O. Box 628
Stuttgart, AR 72160
Quick Pay Option Form:
Please select the preferred payment plan as described below:
Next day pay for a fee of 5% of gross revenue to be paid to the carrier.
(Payment will be mailed the day after receipt of invoice & original B.O.L.)
7 day pay for a fee of 3% of the gross revenue to be paid to the carrier.
(Payment will be mailed 7 days after receipt of invoice & original B.O.L.)
14 day pay for a fee of 2% of the gross revenue to be paid to the carrier.
(Payment will be mailed 14 days after receipt of invoice & original B.O.L.)
Regular pay for no additional charge.
(Payment will be mailed 30 days after receipt of invoice & original B.O.L.)
Factoring company; If you use a factoring company then you must check this
option. (All factoring company’s checks will be mailed 30 days after receipt of
invoice & original B.O.L.)
Company Name:
Authorized Representatives Signature:
Printed Name:
Date:
Factoring Company:
Address:
City:
ST:
Phone:
***You must check one of the above options even if you want
regular pay or you will not be paid***
LEE TRUCK BROKER, INC.
P.O. BOX 628
STUTTGART, AR 72160
FAX: (870) 673-7980
PHONE: (870) 673-6921
WATT: (800) 736-7533
BROKERAGE AGREEMENT
This agreement is entered into between Lee Truck Broker, Inc. Here-in-after referred to
as Broker, and _____________________ here-in-after to as Carrier.
Whereas, Broker is a Transportation Broker engaged in the business of selling or
negotiation transportation in interstate and intrastate commerce over the public or private
highways, airways, railways, waterways, and whereas __________________ operating in
interstate or intrastate commerce pursuant to operating authority issued by the appropriate
commissions.
Now, in consideration of the mutual covenants and promises here-in-after set forth, the
parties agree as follows:
1. The terms of the agreement shall be continuous form signing date.
2. Broker commission shall be set and agreed upon at the time of movement.
3. Termination of this agreement can be instituted by either party by giving 30 days
notice in writing to the other party.
4. The carrier shall be liable for all loss, damage, or liability incurred by
transportation of property arranged for the broker while being transported by
carrier.
5. In the event of disagreement or dispute and legal action is taken, the prevailing
party will be entitled to legal fees.
6. This agreement contains the entire contract agreement and no additions can be
made unless in writing or initialing by both parties.
In witness whereof, the parties hereto have signed their names on this ______________
(date)
in STUTTGART, AR .
______________ 20
(month)
(yr)
(city & state)
LOCATION:
By:
Randy Lee
Witness: Brandon
By: _________________________
Lee
Witness:__________________________
W-9
Request for Taxpayer
Identification Number and Certification
Form
(Rev. October 2007)
Department of the Treasury
Internal Revenue Service
Give form to the
requester. Do not
send to the IRS.
Print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name, if different from above
Check appropriate box:
Individual/Sole proprietor
Corporation
Partnership
Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership)
Other (see instructions)
©
Exempt
payee
©
Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
City, state, and ZIP code
List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Social security number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Employer identification number
Part II
or
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign
Here
Signature of
U.S. person ©
Date ©
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business is not subject to the withholding tax on
foreign partners’ share of effectively connected income.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester’s form if it is
substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
● An individual who is a U.S. citizen or U.S. resident alien,
● A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
● An estate (other than a foreign estate), or
● A domestic trust (as defined in Regulations section
301.7701-7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners’ share of income
from such business. Further, in certain cases where a Form W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
following cases:
● The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X
Form
W-9
(Rev. 10-2007)
Transcredit
Page 1 of 2
Lee Truck Broker Inc
DBA:
Physical Address:
Mailing Address:
2302 South Main
P O Box 628
Stuttgart, AR 72160
Stuttgart, AR 72160
www.transcredit.com
County: Arkansas
This location is: Main Office
Tel: (870) 673-6921
Fax: (870) 673-7980
800: (800) 736-7533
Business Profile
Company History
Corporate Profile
Transportation Credit Score: 100
Business Established:
On File Since:
11/06/1990
Years In Business:
28
Corporate Info Last
Updated:
07/16/2007
Company Organized As:
Corporation
Federal Tax ID# or SSN:
710594700
References Last Updated:
12/21/2007
Number of Employees:
15
Report Date:
05/01/2008
This company is primarily
Freight Broker
engaged in the business of:
Officers / Owners
President:
Randall D. Lee
Other Offices:
Member Of:
TIA
The Transportation Credit Score is based on over 21 years of analysis of the “shippers” ability
to pay. Some of the factors used in compiling the TCredit Score include: Payment Trends,
Time In Business, Financial Strength and Collection Activity. Note: In some instances the
Credit Score my exceed 100 when the file Reflects a Freight Broker that is a “P3” Member of
TIA and has been Bonded for $100,000.00.
SCORE RISK TO YOU
85100
Lowest
70-84 Moderate
55-69 High
1-54
Extreme
0
Too new to
rate
Banking
Corporate Strength
Annual Sales:
$10-20 million
Bank:
Farmers & Merchants Bank
Average Credit Extended:
$28,600.00
Location:
Stuttgart, AR
Average Payment Trend In
Days:
From References
Acct#:
Confidential
26
Average Years Account
Open:
From References
15
Collection ActivitySubmitted To Commercial
Agency Or Attorney:
NONE
Payment Instructions
Original & 1 Copy Of Invoice,Signed Copy Of B/L
Investigator Comments
Public Filings
https://transcredit.com/secure/credit/print.cfm?reportID=27997
5/1/2008
Transcredit
Page 2 of 2
Freight Broker
DOT#: MC177190
If the Company History indicates this company is a Freight Broker or Freight Forwarder or Truck Line the following is a
record of their Operating Authority, Bond and Insurance as shown by the Federal Department of Transportation (DOT).
These records are acquired by TransCredit every 30 days.
DOT Auth & Insurance
Bond
Number
Company
Attn
69134099
WESTERN SURETY CO.
City
St
Date
Tel
SD
04/10/2001
(605) 336-0850
Fund
Cargo
Liab
DOT Auth & Insurance
DOT Auth & Insurance
Broker
Contract
Authority
Active
No
Pending
No
Revoked
No
Common
No
Bond-Req
Cargo-Req
BiPd-Req
No
Req
Yes
No
No
No
On-File
10,000
No
0
No
Transportation Credit References
All References Refer to Freight Bill Payment-Unless Specified As Trade. References indicated as "Confidential" are from
Carriers participating in our Freight Payment Exchange Program.
Location
Years Avg
Open Cred/Month
Payment
Trend
Terms
Current
Balance
Last Sale
Date
Collections
Trade
Ref G & H
1
Transportation
Stuttgart,
AR
20
$8,000.00
30.0
N30
$0.00
01/12/07
No
No
Ref Kenny Adams
2
Trucking
Wynne, AR 20
$20,000.00
10.0
N30
$0.00
08/07
No
No
Ref
Ralph Walker Inc
3
Richland,
MS
20
$15,000.00
30.0
N30
$0.00
09/07
No
No
Ref Crumpler & Son
4
Brokerage, Inc
Pharr, TX
12
$75,000.00
30.0
N30
$0.00
11/07
No
No
Ref
Millwood Trucking
5
Nashville,
AR
5
$25,000.00
30.0
N30
$0.00
5/07
No
No
Name
While every effort has been made to ensure that the information contained herein is accurate and complete at the time
of presentation. TransCredit, Inc., its affiliates and/or subsidaries shall not be liable for any damages of any kind
resulting from use of or reliance on this credit report or information contained herein. This report contains information
obtained from TransCredit subscribers and other sources. It has been prepared for the exclusive use of the customer as
a factor to consider in connection with credit or other business decisions.
https://transcredit.com/secure/credit/print.cfm?reportID=27997
5/1/2008
TRADE REFERENCES DAN BILLINGSLEY TRUCKING, INC.
9197 HWY 261 PALESTINE, AR 72372 ATTN: DAN 870‐261‐3776 RALPH WALKER, INC. 625 OLD HWY 49 SOUTH RICHLAND, MS 39218 ATTN: RALPH 601‐939‐3104 KENNY ADAMS TRUCKING, LLC.
P.O. BOX 97 WYNNE, AR 72396 ATTN: KENNY, SARAH 870‐238‐8860 WARREN HAULING
203 AVE 6 NE ATKINS, AR 78283 ATTN: CARL, JASON 479‐641‐1968 CRUMPLER & SONS BROKERAGE, INC.
P.O. BOX 787 PHARR, TX 78577 ATTN: GREG 800‐274‐7570 OZARK TRUCK BROKERS, INC. 3806 KELLEY AVE SPRINGDALE, AR 72766 ATTN: DAVE, JERRY 800‐643‐3700 J‐MAR EXPRESS P.O. BOX 9198 SEARCY, AR 72143 ATTN: RICK, WIT 501‐268‐8969 K&M EXPRESS
2200 SOUTHFIELD ROAD EL DORADO, AR 71730 ATTN: ROBIN 870‐863‐8300