MC Authority

MC (Motor Carrier) Authority
Company Name*
President/Owner's Name*

First NameLast Name
Title (President, Owner, Manager, etc.)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Phone Number*

Area CodePhone Number
Contact Phone Number

Area CodePhone Number
Email*
example@example.com
S Corporation?*

YesNoDon't know
IFTA registration*

YesNo
Number of IFTA decals needed
Hazmat?*

YesNo
Canada permits?*

YesNo
Type of trailer used*

Dry vanReeferFlat bedCar haulerTanker
State permits needed*

KentuckyNew MexicoNew YorkOregonNone
Help with insurance?*

YesNoMaybe
Illinois Intrastate Authority*

YesNoDon't know
Truck/trailer description (year, make, vin #)
Notes
I am aware that by submitting this form I give my permission to Prospect Licensing & Consulting Inc to process my application for a motor carrier authority as well as any permits needed to complete the process.*

Yes
Should be Empty:

MC (Motor Carrier) Authority