TRUCKING APPLICATION

Trucking Application

COMPANY DETAILS
ALREADY UP AND FULLY RUNNING? *

YES NO
TELL US HOW WE CAN HELP?
MC#
DOT#
COMPANY NAME
DBA (IF ANY)
**IF YOU NEED COD TO OBTAIN A TELEPHONE NUMBER OR EMAIL PLEASE LEAVE THE FOLLOWING FIELDS BLANK**
COMPANY EMAIL
example@example.com
COMPANY PHONE NUMBER
Please enter a valid phone number.
COMPANY TYPE

SOLE PROPRIETORSHIP PARTNERSHIP LLC CORPORATION NON-PROFIT IF YOU NEED TO BE FULLY FORMED BY COD AS WELL, CHECK HERE
EIN? (SKIP IF NO, IF YES PLEASE ATTACH YOUR CP 575 LETTER)
File Upload

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CONTACT NAME

First Name Last Name
SOCIAL SECURITY NUMBER
TITLE
CONTACT PERSONAL PHONE NUMBER
Please enter a valid phone number.
CONTACT ADDRESS

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
COMPANY ADDRESS?

CLICK HERE IF COMPANY ADDRESS IS THE SAME AS CONTACT ADDRESS
Address if different from above.

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
ADDITIONAL OWNERS

GVW (Weight of truck and trailer fully loaded)
INTRASTATE(WITHIN YOUR STATE) INTERSTATE(ACROSS STATE LINES)
DOT # (IF NONE PLEASE SKIP)
MC# (IF NONE SKIP)
NUMBER OF TRUCKS
WHAT TYPE OF TRUCKS ARE YOU RUNNING? CHECK ALL THAT APPLY

SEMI TRUCK DUMP TRUCK BOX TRUCK PICK-UP TRUCK VAN Other
DRIVER INFORMATION

LIST THE NUMBER OF DRIVERS FOR EACH SECTION
Total # of CDL Drivers
Total # of Drivers
Interstate within 100 mi.
Intrastate within 100 mi.
Interstate beyond 100 mi.
Intrastate beyond 100 mi.
Operations
What type of Authority Do You Need?

Carrier Broker Hauling My Own Property Moving Company Other
Hazardous Materials

YES NO
Cargo Type

General Freight - Transports a wide variety of goods. Will suffice for most products. More - Choose from additional cargo types if you have specialized equipment or have a contract to haul something very specific. Please check all that applies.
more extended

Fresh Produce Chemicals - Hazmat required. Commodities Dry Bulk Refrigerated Foods Beverages Paper Products Utilities Agricultural / Farm Supplies Construction US Mail - Government contract required. Metal: Sheets, coils, rolls Motor Vehicles Drive/Tow Away Logs, Poles, Beams, Lumber Building Materials Mobile Homes Machinery, Large Objects Garbage / Refuse Liquids/Gases - Hazmat required Intermodal Containers - SCAC code required. Passengers Oilfield Equipment Livestock Grain, Feed, Hay Coal/Coke Meat Water Well Other
YES! SIGN ME UP FOR FACTORING - receiving same day payments on my loads. NO THANKS
YES! SIGN ME UP FOR FUEL PROGRAMS - get fuel advance credit card NO THANKS
YES! SIGN ME UP FOR LODGING PROGRAMS - get lodging advance for your long hauls NO THANKS
Please Check All that Applies if you are wanting COD to perform these services for your company:

Registered Agent Service Process Agent Management Service INSURANCE ASSISTANCE FLEET ASSISTANCE STAFFING ASSISTANCE Other
**UPON FILING THE FOLLOWING MAY BE REQUIRED AS WELL DEPENDING ON FMCSA COMLIANCE**

BOC3, UCR, IFTA, IRP, 2290, DQF, D&A Consortium, UCR,TX DOT Number, CA Number & Permit, DQF, OR Weight Distance Permit, NM Weight Distance Permit, KY KYU Weight Distance Permit, NY HUT Weight Distance Permit, & SCAC Code.
Special Instructions?
PLEASE ATTACH YOUR DRIVER'S LICENSE (ALL BUSINESS OWNERS)TO THIS APPLICATION *

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As soon as you obtain a DOT Number, all of your personal contact information becomes public. Unfortunately, this means that you will get spammed via phone and email. In order to protect you from that, we do not enter your personal information into the FMCSA database for the 21-day protest period.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.
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	NAME	FULL ADDRESS	SOCIAL	EMAIL	SOCIAL	%OF OWNERSHIP
OWNER
OWNER
OWNER
OWNER
OWNER
OWNER

Trucking Application

**IF YOU NEED COD TO OBTAIN A TELEPHONE NUMBER OR EMAIL PLEASE LEAVE THE FOLLOWING FIELDS BLANK**

DRIVER INFORMATION

Operations

**UPON FILING THE FOLLOWING MAY BE REQUIRED AS WELL DEPENDING ON FMCSA COMLIANCE**

IF YOU NEED COD TO OBTAIN A TELEPHONE NUMBER OR EMAIL PLEASE LEAVE THE FOLLOWING FIELDS BLANK

UPON FILING THE FOLLOWING MAY BE REQUIRED AS WELL DEPENDING ON FMCSA COMLIANCE