New Authority Application

New Authority Application
Business Information
Business Name
Business Type

Sole Proprietorship Partnership LLC Corporation
What Type of LLC?
EIN (If none, skip)
Business Contact Other Than Owner(s)?
Business Contact Name
Business Phone Number
Business Email
Principal(s) of Business
First Name
Last Name
Title
% Ownership
Home Address
City
State
ZIP
Cell Number
Email Address
Social Security #
Additional Owners

Additional Owners
First Name
Last Name
Title
% Ownership
Home Address
City
State
ZIP
Cell Number
Email Address
Social Security #
Different Addresses

Different Home Mailing Address? Different Business Address? Different Business Mailing Address?
Home Mailing Address
City
State
ZIP
Business Address
City
State
ZIP
County
Business Mailing Address
City
State
ZIP
County
GVW (Weight of truck and trailer fully loaded)
Interstate (multiple states) Intrastate (just one state)
DOT Number (if none skip)
Number of Trucks
Fleet Description

List each truck in your fleet, if none skip ahead to Driver Information. Attach another page if needed.
Unit #
Year
Make & Model
VIN
Semi Truck Dump Truck Pick-up Box Truck
Additional Trucks?
Unit #
Year
Make & Model
VIN
Semi Truck Dump Truck Pick-up Box Truck
Additional Trucks?
Unit #
Year
Make & Model
VIN
Semi Truck Dump Truck Pick-up Box Truck
Additional Trucks?
Unit #
Year
Make & Model
VIN
Semi Truck Dump Truck Pick-up Box Truck
Additional Trucks?
Unit #
Year
Make & Model
VIN
Semi Truck Dump Truck Pick-up Box Truck
Additional Trucks?
Unit #
Year
Make & Model
VIN
Semi Truck Dump Truck Pick-up Box Truck
Additional Trucks?
Unit #
Year
Make & Model
VIN
Semi Truck Dump Truck Pick-up Box Truck
Additional Trucks?
Unit #
Year
Make & Model
VIN
Semi Truck Dump Truck Pick-up Box Truck
Driver Information

List the number of drivers for each category
Interstate within 100 mi.
Interstate beyond 100 mi.
Intrastate within 100 mi.
Intrastate beyond 100 mi.
Total # of Drivers
Total # of CDL Drivers
Operations
Select One or More

For Hire Private Property Broker Government Contract
What type of Authority Do You Need?

Carrier Broker Hauling My Own Property Moving Company
Hazardous Materials

Yes No
Cargo Type

General Freight Fresh Produce US Mail Liquids/Gases Chemicals Metal: Sheets, coils, rolls Intermodal Containers Commodities Dry Bulk Motor Vehicles Passengers Refrigerated Foods Drive/Tow Away Oilfield Equipment Beverages Logs, Poles, Beams, Lumber Livestock Paper Products Building Materials Grain, Feed, Hay Utilities Mobile Homes Coal/Coke Agricultural / Farm Supplies Machinery, Large Objects Meat Construction Garbage / Refuse Water Well
I am Interested in Factoring (Receiving Same Day Payments)
Free Authority Package (DOT, MC, BOC3, UCR) $0 Free DOT Package (DOT) $0
Free Authority Terms Authorization. (By checking this box you agree to the below terms.)
Free Operating Authority consists of MC, DOT, BOC-3, and UCR filings. Free means no filing fees will be assessed by Authority Express LLC for preparing these filings. You will still be responsible for any government or other fees related to these filings. You agree to engage Integrity Factoring & Consulting, Inc. for the purposes of entering into a factoring agreement and hereby authorize them to file a UCC-1 Financing Statement on all principals granting Integrity Factoring & Consulting, Inc. a security interest in the following collateral: All present and future assets of the Debtor. Should you cancel this authorization without receiving factoring services, you agree to pay Integrity Factoring a termination fee in the amount of $1000.00. You hereby grant Integrity Factoring to verify any or all of the foregoing statements, including but not limited to your credit worthiness and financial responsibility. All services are contingent upon Integrity Factoring's review, verification and final written approval. If you fail to complete the factoring setup within 60 days you agree to pay Authority Express LLC full price for services rendered. If you are not approved for factoring you are not eligible for the Free Authority.
PRICES DO NOT INLCLUDE GOVERNMENT FEES
Complete Authority Package (DOT, MC, BOC3, UCR, IFTA, IRP, 2290) $950 Basic Authority Package (DOT, MC, BOC3, UCR) $535 Post Authority Package (IFTA, IRP, 2290) $475
The IRS does not allow you to pay your 2290 with a credit card. Please provide a bank account and routing number.
Bank Account
Routing Number
Additional Services

Obtain EIN Number $85 Create Business Entity $190 DOT Number $250 Update DOT Number to interstate $85 UCR $85 2290 $85 TX DOT Number $130 CA Number & Permit $175 IFTA License $170 IRP Account Setup $220 Enrolled in Drug Consortium Pool $80 Driver Qualification File $150 Annual Weight Distance Tax Permit $85 each Authority Name Change $220 Full Decals (Company Name, City & State, DOT & MC) $50/ pair DOT Decal Stickers $25/ pair MC Decal Stickers $25/ pair DOT & MC Decal Stickers $35/ pair CA# Decal Stickers $25/ pair TX# Decal Stickers $25/ pair KYU# Decal Stickers $25/ pair
Special Instructions?
Choose Decal Color

Black White Red
KY NM NY OR
Keep Me Legal All Year Long for $75 a month. (1-2 trucks, each additional truck $10)
Annual Services - 4 Quarters of IFTA Taxes, IFTA License Renewal, Renew Apportioned Plates, UCR, 2290, USDOT Update
PLEASE ATTACH YOUR DRIVER'S LICENSE (ALL BUSINESS OWNERS) TO THIS APPLICATION *

Browse Files

Cancel of
Credit Card Information
PLEASE ATTACH A PHOTO OF THE DEBIT / CREDIT CARD THAT YOU WISH TO USE FOR PAYMENT *

Browse Files

Cancel of
Name on Card
Card Number
Card Number
Exp. Date *
CVC *
Billing Zip Code *
By submitting you agree to be charged for the above services. The fees listed are for Authority Express LLC services. You will still be responsible for any government fees related to these filings. The above card will be used for those to complete the filings requested.
Should be Empty:

New Authority Application

Business Information

Principal(s) of Business

Fleet Description

Driver Information

Operations

Credit Card Information