MCS-150 FILING (PAID THROUGH STRIPE)

MCS-150 FILING
REASON FOR FILING (select only one):*

New ApplicationBiennial Update or ChangesOut of Business NotificationReapplication (after revocation of new entrant)
LEGAL BUSINESS NAME:*
DOING BUSINESS AS NAME (if different from Legal Business Name):
DO YOU HAVE YOUR FMCSA PIN? Your PIN number is a series of letters and numbers ex: 1A23BC4D If you do not have your PIN, we will contact you to help you retrieve it.

YESNO
FMCSA PIN (if you do not know your PIN, we will contact you by phone)
ex-GJ24UJ67
PRINCIPAL PLACE OF BUSINESS:
Address*

3. STREET ADDRESS/ROUTE NUMBER

Street Address Line 2

4. CITY5. STATE/PROVINCE

6. ZIP CODECountry
MAILING ADDRESS:*

Same as Principal Address
Mailing Address

3. STREET ADDRESS/ROUTE NUMBER

Street Address Line 2

4. CITY5. STATE/PROVINCE

6. ZIP CODECountry
PRINCIPAL BUSINESS PHONE NUMBER*

Area CodePhone Number
PRINCIPAL CONTACT CELL PHONE NUMBER

Area CodePhone Number
PRINCIPAL BUSINESS FAX NUMBER

Area CodePhone Number
USDOT NUMBER*
MC or MX NUMBER
IRS/TAX ID NUMBER*
E MAIL ADDRESS:*

Confirmation Email Confirm Email Address
CARRIER MILEAGE (to nearest 10,000 miles for the previous 12 months):*
COMPANY OPERATIONS (check all that apply):
Carrier*

A. Interstate CarrierB. Intrastate HazmatC. Intrastate Non-HazmatD. Interstate HazmatE. Intrastate Hazmat
OPERATION CLASSIFICATIONS (check all that apply):
Passengers (Business)*

A. Authorized For-HireD. Private Motor Carrier ofG. U.S. MailL. Other:B. Exempt For-HireH. Federal GovernmentC. Private PropertyE. Private Motor Carrier ofI. State GovernmentF. MigrantJ. Local GovernmentK. Indian Tribe
CARGO CLASSIFICATIONS (check all that apply):*

A. General FreightI. Machinery, Large ObjectsQ. Coal/CokeY. Paper ProductB. Household GoodsJ. Fresh ProduceR. MeatZ. UtilityC. Metal: Sheets, Coils, RollsK. Liquids/GasesS. Garbage, Refuse, TrashAA. Farm SuppliesD. Motor VehiclesL. Intermodal ContainerT. U.S. MailBB. ConstructionE. Drive Away/TowawayM. PassengersU. ChemicalsCC. Water WellF. Logs, Poles, Beams, LumberN. Oil Field EquipmentV. Commodities Dry BulkDD. Other:G. Building MaterialsO. LivestockW. Refrigerated FoodH. Mobile HomesP. Grain, Feed, HayX. BeveragesOther
Do you transport Hazardous Materials?

YesNo

Number of Vehicles Operated in the US:

Trucks and Trailers

	Straight Trucks	Truck Tractors	Trailers	Hazmat Cargo Tank Trucks	Hazmat Cargo Tank Trailers	Motor Coach
Owned
Term Leased
Trip Leased

Do you transport Passengers?

YesNo
Number of vehicles carrying number of passengers, including the driver:

Driver Information

	16+ passengers
Owned
Term Leased
Trip Leased

Driver Information*

	Interstate (crossing state lines)	Intrastate (within state lines)
Within 100-mile radius
Beyond 100-mile radius

Total Number of Drivers*
Number of CDL Drivers*
28. IS YOUR USDOT NUMBER REGISTRATION CURRENTLY REVOKED BY THE FMCSA?*

YesNo
If yes, enter your USDOT Number:
ALL MOTOR PASSENGER CARRIER APPLICANTS must certify as follows: Applicant is !t, willing, and able to provide the proposed operations and to comply with all pertinent statutory and regulatory requirements, including the U.S. Department of Transportation’s Americans with Disabilities Act regulations for over-the-road bus companies located at 49 CFR Part 37, Subpart H, if applicable.*

YES
PLEASE ENTER NAME(S) OF SOLE PROPRIETOR, PARTNERS, OR OFFICERS AND TITLES

(e.g., president, treasurer, general partner, limited partner)
1.
2.
CERTIFICATION STATEMENT (to be completed by authorized official):
(please type or print name)
I, named above, certify that I am familiar with the Federal Motor Carrier Safety Regulations and/or Federal Hazardous Materials Regulations. Under penalties of perjury, I declare that the information entered on this report is, to the best of my knowledge and belief, true, correct, and complete.
Signature

Clear
Title (please type or print)
Date:

MonthDayYear
Date
Use this link to pay: Click Here
Should be Empty:

	Type of Material	Carrier	Shipper	Bulk	In Cargo Tanks	Non-Bulk	In Packages
Material 1
Material 2
Material 3
Material 4

MCS-150 FILING

Number of Vehicles Operated in the US:

Driver Information