2024 UCR Registration Assistance Form
Unified Carrier Registration is required for interstate motor carriers, brokers and freight forwarders. Mandated as per 49 U.S Code §14504a. Prior to placing your UCR order, please confirm that you have not already finalized a UCR registration.
LEGAL BUSINESS NAME:
*
DOING BUSINESS AS NAME
USDOT NUMBER
*
E-MAIL ADDRESS
*
PRINCIPAL PLACE OF BUSINESS:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE NUMBER
*
Format: (000) 000-0000.
Number of Interstate Vehicles operated under your USDOT#
*
Carrier Classification (Check all that apply)
Motor Carrier
Freight Forwarder
Broker
Leasing Company
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Terms and Conditions
*
Name
*
First Name
Last Name
Title
*
Signature
*
Date
-
Month
-
Day
Year
PAYMENT INFORMATION
My Products
*
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2024 UCR - Bracket 0-2 vehicles
$
142.00
2024 UCR - Bracket 3-5 vehicles
$
261.00
2024 UCR - Bracket 6-20 vehicles
$
489.00
2024 UCR - Bracket 21-100 vehicles
$
1,498.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
If the registration is already in compliance, I hereby grant authorization for NCC to
*
Utilize the payment for the upcoming registration.
Process a refund to my initial payment method.
Submit
Submit
Should be Empty: