Request to Authorize Me

RED DOG LOGISTICS INC

DOT Number: 2364036

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First Name

Last Name

Title

Cell Phone Number

User Name

Password

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I understand that my data is used in the same manner as a faxed or emailed carrier packet would be. I give Assure Assist, Inc. permission to distribute the data I provide on MyCarrierPortal.com to ONLY companies I E-SIGN agreements with on MyCarrierPortal.com (the inviters), the inviters' compliance monitoring company, and the inviters' Transportation Management Software System.

Your email address will be used only to receive confirmation of completed online packets, receipts, online packet invitations, insurance certificate related concerns, compliance concerns, and general information regarding my MyCarrierPortal.com account. Your email address is only provided to the companies you complete a MyCarrierPacket for and/or their compliance monitoring company.

I have read and understand the Assure Assist E-SIGN & UETA Disclosure & Consent Agreement. Click here to view the consent & disclosure agreement.

I certify under penalty of perjury under the laws of the United States of America that I am authorized to sign agreements and W9 forms on behalf of RED DOG LOGISTICS INC.