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My account
Please enable JavaScript in your browser to complete this form.
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Contact Info - Full Name
*
First
Middle
Last
Contact Title
Mr., Ms. Mrs., Miss, Dr..
Applicant Street Address
*
City, State, Postal Code
*
Contact Telephone Number
*
Contact Cell Phone Number
*
Fax Number
Contact Info - Email Address
*
Preferred Contact Method
*
--- Select Choice ---
Telephone
Cell Phone
Email
Business Info - Legal Business Name
*
Business Info - DBA
(If Name is Different From Legal Business Name)
Is the Principal Place of Business the Same as the Applicant Contact Address?
*
Yes
No
If Not, Add Business Address
EIN or SSN
*
Is the Applicant a Unit of Government?
Yes
No
Form of Business (Select the business form that applies)
*
Sole Proprietor
Partnership
Limited Liability Company (LLC)
Corporation
Limited Liability Partnership (LLP)
Trusts
Other
Ownership and Control
*
Owned/Controlled by citizen of US
Owned/Controlled by citizen of Canada
Owned/Controlled by citizen of Mexico
Owned/Controlled by citizen of other foreign country
Company Contact #1
First
Middle
Last
Company Contact - Email
Company Contact - Telephone Number
Company Contact Address
Street, City, State, Zip
Will the Applicant Operate as an Intermodal Equipment Provider?
*
Yes
No
Will the Applicant Transport Property?
*
Yes
No
Will the Applicant Receive Compensation for the Business of Transporting the Property Belonging to Others?
*
Yes
No
What Type of Property will the Applicant Transport? (Select All That Apply)
*
Hazardous Materials
Household Goods
Exempt Commodities
Other Non-Hazardous Freight
Will the Applicant Transport Non-Hazardous Materials Across State Lines, Otherwise Known as Interstate Commerce?
*
Yes
No
Will the Applicant Transport Their Own Property?
*
Yes
No
Will the Applicant Transport Any Passengers?
*
Yes
No
Will the Applicant Provide Property or Household Goods (HHG) Broker Services?
*
Yes
No
Will the Applicant Provide Freight Forwarder Services?
*
Yes
No
Will the Applicant Operate a Cargo Tank Facility?
*
Yes
No
Will the Applicant Operate as a Towaway?
*
Yes
No
Operations Classification - Please Select all Classifications of Cargo that the Applicant will Transport or Handle.
*
General Freight
Household Goods
Metal: Sheets, Coils, Rolls
Motor Vehicles
Drive Away/Tow Away
Logs, Poles, Beams, Lumber
Building Materials
Mobile Homes
Machinery, Large Objects
Fresh Produce
Liquids/Gasses
Intermodal Cont.
Passengers
Oil Field Equipment
Livestock
Grain, Feed, Hay
Coal/Coke
Meat
Garbage, Refuse, Trash
US Mail
Chemicals
Commodities Dry Bulk
Refrigerated Food
Beverages
Paper Product
Utility
Farm Supplies
Construction
Water Well
Other
Provide Number of Non-CMV's the Applicant Plans To Operate
*
Number of Commercial Vehicles Operating - Straight Truck
*
Number of Commercial Vehicles Operating - Truck Tractor
*
Number of Commercial Vehicles Operating - Trailers
*
Number of Commercial Vehicles Operating IEP Trailer Chassis Only
*
applies) Vehicles for
Are the Vehicles Owned, Term Leased, Trip Leased, Tow/Driveaway, or Serviced?
*
Number of Commercial Motor Vehicles the Applicant will Operate in Canada or Mexico?
*
Number of Commercial Motor Vehicles the Applicant will Operate Solely in Interstate Commerce?
*
Number of Commercial Motor Vehicles the Applicant will Operate Solely in Intrastate Commerce?
*
Number of Drivers Operating as Interstate within 100 air-mile radius?
*
Number of Drivers Operating as Interstate Beyond a 100 air-mile radius?
*
Number of Drivers who will Operate Solely as Intrastate within a 100 air-mile radius?
*
Number of Drivers who will Operate Solely as Intrastate Beyond a 100 air-mile radius?
*
What are the number of drivers with a Commercial Driver’s License (CDL), (LFC), or valid Canadian License Class 1,2,3,4 or Class A,B,C, D if licensed in Ontario
*
Number of Drivers who will Operate in Canada or Mexico?
*
Will any of the property get transported in vehicles >= 10,001 pounds?
Yes
No
Do you currently or in the last 3 years have you had any relationship involving common stock, common ownership, common management, common control or familial relationships or any other person or applicant for registration?
*
Yes
No
Submit Application Registration
