Get Started here and $ave money!

I AM APPLYING FOR THE FOLLOWING AUTHORITY(S) 
FREIGHT or PASSENGER 

Motor Carrier:
Common Contract

Type of Commodity Requested:

• General Freight;

• Household Goods and/or

• Hazardous Materials

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Broker:
Broker (except Household Goods) 
Broker (of Household Goods)

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Freight Forwarder:
Freight Forwarder (except Household Goods)
Freight Forwarder (of Household Goods)

For Freight Forwarder's only:

 

I own trucks. (Minimum of $750,000 BI&PD required + cargo)
I do not own any trucks. (only cargo insurance required)

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I WILL BE TRANSPORTING THE FOLLOWING COMMODITIES:
(Freight carriers only)

General commodities, non-hazardous commodities 
(Minimum of $750,000 BI&PD required)

Household goods (The term "household goods' embraces not only personal effects and property from a residence to residence, but also relocations of offices, museums or the transportation of displays, etc.)
(Minimum of $750,000 BI&PD required)

Hazardous materials that require a minimum of $1,000,000 BI&PD 
(HAZMAT certificate application required)

Hazardous materials that require a minimum of $5,000,000 BI&PD 
(HAZMAT certificate application required)

NOTE: Common Carriers must have a minimum of $10,000 cargo insurance.

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FOR PASSENGER CARRIERS ONLY

Passenger carrier transporting 1-8 passengers
(Minimum of $1,500,000 BI&PD required)

Passenger carriers transporting 9-15 passengers 
(Minimum of $1,500,000 BI&PD required)

Passenger carriers transporting more than 15 passengers.  
(Minimum of $5,000,000 BI&PD required)

Does not apply

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Will operate vehicles having Gross Vehicle Weight Ratings 
(GVWR) of 10,000 pounds or more.

Will operate vehicles having GVWR under 10,000 pounds.

I do not have any vehicles.

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APPLICANT NAME *Required

DOING BUSINESS AS: 

SSN or EIN: 

PHYSICAL ADDRESS, CITY, STATE & ZIP CODE

MAILING ADDRESS, CITY, STATE & ZIP CODE

TELEPHONE NUMBER:    * Required

FAX NUMBER :

 EMAIL ADDRESS:
* Required

BUSINESS TYPE: 
Individual;
Partnership;
Corporation (State - );
LLC (State -

Name of Owner/Officer: * Required
 

Title of Owner/Officer: Owner Partner President Vice President Other - Please specify
If other, please specify:

ACTUAL COMMODITIES TO BE TRANSPORTED:

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YOU MUST ANSWER "YES" OR "NO" TO THE FOLLOWING QUESTIONS:

1. Do you have ICC/FHWA Authority now?
(Yes) or (No)  MC#

2. Do you or anyone connected with company now have interest in any other ICC/FHWA regulated carrier or broker?
(Yes) or (No) 
If "YES" list Name of Company
and MC#

3. Have you ever had a DOT Safety Audit?
(Yes) or (No) 

PRESENT DOT NUMBER (IF ANY)

Safety Rating (If any)  None Satisfactory Conditional Unsatisfactory

4. (Yes) or (No) Have you been convicted after September 1, 1989, of distribution or possession of a controlled substance?

5. (Yes) or (No) Will your operations be conducted in compliance with the DOT rules and regulations or safety?

6. (Yes) or (No) Are you domiciled, owned, or controlled by persons in Mexico?

7.  (Yes) or (No) Are you a US Citizen?

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Would you like us to tell you how much it will cost you for your Fuel Permit?

YES! - please send me a - FREE - Fuel Permit Quote, too!
(Note: State Permits are not included in the price of the authority.  A detailed quote will be sent to you according to the state specifications you designate below.)

#Number of Vehicles: Gross Vehicle Weight:   

IFTA/Mileage Tax Permits:  

IFTA     Base State :  KY; NM; NY; OR (Bond Required)

Yes, send me more information about Fuel Tax Reporting Service.

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Payment Method:  Select one... Use Credit Card information below. (SSL secured) Cashiers Check or Postal Money Order Comcheck *required Credit Card Information Type: Select One... MasterCard Visa American Express Discover   Amount Charged: Select $350.00 Single Authority Total $380 to include BOC-3 Card Number: Expiration: Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Security Code: (4 digits for AMEX; 3 digits for all other card types) Cardholder Name: Indicate by typing "Yes" that Cardholder authorizes Rex Evilsizor to charge $350 to my credit card for my motor carrier and/or broker and/or freight forwarder authority.  (Or $380 to include BOC-3) Billing Street Address: Billing Zip Code:

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NOTICE:  The FMCSA (Federal Motor Carrier Safety Administration) DOES NOT refund filing fees.  However, changes can be made...

All information is strictly CONFIDENTIAL and is NOT SHARED with anyone!  There is no obligation.

How did you hear about us?

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NOTICE:   The following information is necessary if you are going to transport in interstate transportation.

How many (Straight Trucks) (Truck Tractors) (Trailers)?

How many drivers with CDL?

Drivers driving in interstate within 100-mile Radius:

Drivers driving in interstate beyond 100-mile Radius:

((NOTE: If this form does not "Submit Application" properly, print form and fax to: 866-729-5904.)))

 (((NOTE:  Or just call Rex at 866-382-6638.)))