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Information We Need

Your Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Social Security Number*
Driver's License Number*
Driver's License State*
Your Business
Legal Business Name*

If it is a Sole Proprietorship or a Partnership the Legal Name is the name of the owner(s) (Ex. John A. Doe). If it is a Corporation or LLC, the Legal Name is the name of the Corporation or LLC (Ex. Acme, Inc.) Doing Business As (DBA)
Company EIN*

Numbers and dashes only.
Physical Address*
Street Address City State ZIP Code
Mailing Address
If different than your Physical Address.

P.O. Box or alternate street address City State ZIP Code
Email*
Enter Email Confirm Email
Preferred Contact Phone #*
Mobile #
FAX #
Services I’m Interested In (please give specific information in the notes section)*
- Starter Kit
- Quarterly Fuel/Mileage Tax Filing
- Drug & Alcohol Consortium
- Authority Services
- USDOT Services
- Unified Carrier Registration
- IFTA & Weight Distance Tax Permits
- Heavy Highway Use Tax (form 2290)
- EIN number (federal tax ID number)
Service Interest Notes
Existing USDOT Number
USDOT Number
PIN Number
Will you...*
- haul for for hire
- haul your own property
- haul hazardous materials
What type of freight will you haul?*
Briefly describe your cargo.
Vehicle Information
Please enter the number of each below its name.
Straight Trucks
Truck Tractors
Trailers
Pickup Trucks
Motor Coach
Mini Bus
16 plus passengers
Passenger Van
1-8 or 9-15 passengers
Driver Information
Please enter the number of drivers who drive...
Interstate = Crossing over state lines.
Intrastate = Staying within base state.
Interstate
within 100 mile radius
Interstate
beyond 100 mile radius
Intrastate
within 100 mile radius
Intrastate
beyond 100 mile radius
Total #
of drivers
Total #
of CDL drivers
Share any additional driver information here:
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LET’S GET STARTED

Information We Need

Your Business

Existing USDOT Number

Vehicle Information

Driver Information