Interstate Authority application

Interstate Authority Application

Epic Services LLC
Name

First NameMiddle NameLast Name
Business Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (If different from address above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Alternative Number (optional)
Please enter a valid phone number.
Fax Number (optional)
Please enter a valid phone number.
Email
example@example.com
FEIN:(Federal Employer Identification Number) *
How Many Trucks?*
How Many Trailers?*
How Many Drivers?*
What will you be hauling?*
Do you have a DOT number?*

YESNO
DOT number
You may pay with a credit card, ACH, Fleet One Check, EFS Check, T-Check or Comcheck. If you are paying with a credit card there is a 4% convenience fee. There will be a $25.00 bank fee for returned checks. If you have any questions, please contact us at:

(770)873-4666 or info@epicservga.com. Thank you
EPIC SERVICES LLC - 422 N INDIAN CREEK DRIVE, SUITE B, CLARKSTON, GA 30021

INFO@EPICSERVGA.COM

(770)873-4666
Should be Empty:

Interstate Authority Application