Reinstatement Authority Application

Reinstatement Authority Application
Full Name*

First NameMiddle NameLast Name
Company Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*

Area CodePhone Number
Fax number:

Area CodePhone Number
Email*
example@example.com
FEIN:(Federal Employer Identification Number)
What is you MC NUMBER?*
What is your US DOT NUMBER?*
How did you hear about us?*

OnlineTruck PaperOtherReferral
You may pay with a credit card,ACH, Fleet one check, EFS check, T-Check or Comchek. 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 our authorities department at (877) 233-9014 extension 1 or by fax at (770) 228-4242.
The Financial Integrity Group-410 East Taylor Street Suite G Griffin, GA 30223

authorities@tfig.org
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