Carrier
Operation:
Interstate
Non-Haz Mat
(Crosses state lines and and never
transports hazardous materials.)
Interstate
Haz Mat
(Crosses state lines and
transports hazardous materials.)
Intrastate
Only Non-Haz Mat
(Never crosses state lines and
never transports hazardous materials.)
Intrastate
Only Haz Mat
(Never crosses state lines and
transports hazardous materials.)
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Carrier
Classification:
Authorized
For Hire
(A motor carrier operating for
hire, as a contract or common carrier of property or
passengers and operating under federal operating
authority.)
Exempt
For Hire
(A motor carrier operating for
hire transporting exempt commodities only. Exempt
commodities include produce, agricultural products
and raw forest products.)
Private
(A not-for-hire motor carrier
which transports their own property exclusively.)
OTHER: see FAQS
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Carrier
Mileage:
Check if this is a new operation
If not new, please state last year's mileage
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Do any
drivers operate vehicles in excess of 26,000 pounds?Yes
No
Number of drivers that operate Interstate
within 100 mile radius:
Number of drivers that operate Interstate
beyond 100 mile radius:
Number of drivers that operate Intrastate Only
within 100 mile radius:
Number of drivers that operate Intrastate Only
beyond 100 mile radius:
Total number of drivers:
Total Number CDL Drivers:
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List number
of equipment owned in each of the following
categories. (Include all finance leased equipment in
this category as well as all owned equipment.):
If no
equipment is owned, check here:
Straight
trucks:
Truck
Tractors:
Trailers:
Hazmat Cargo Tank Trailers:
Hazmat Cargo Tank Trucks:
Motor Coach (buses)
School Bus (By Number of passengers including
driver) 1-8
9-15
16plus
Minibus (By Number of passengers including driver)
16plus
Van (By Number of passengers including driver) 1-8
9-15
Limousines (By Number of passengers including driver)
1-8 9-15
16plus
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List number
of equipment Term Leased. (Indicate the # of
vehicles leased for 30 or more days from other
motor carriers to you.):
If no
equipment is term leased, check here:
Straight trucks:
Truck Tractors:
Trailers:
Hazmat Cargo Tank Trailers:
Hazmat Cargo Tank Trucks:
Motor Coach (buses)
School Bus (By Number of passengers including
driver) 1-8
9-15
16plus
Minibus (By Number of passengers including driver)
16plus
Van (By Number of passengers including driver) 1-8
9-15
Limousines (By Number of passengers including driver)
1-8 9-15
16plus
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List number
of equipment Trip Leased. (Indicate the
number of vehicles trip leased for less than 30
days from other motor carriers to you.):
If no
equipment is trip leased, check here:
Straight trucks:
Truck Tractors:
Trailers:
Hazmat Cargo Tank Trailers:
Hazmat Cargo Tank Trucks:
Motor Coach (buses)
School Bus (By Number of passengers including
driver) 1-8
9-15
16plus
Minibus (By Number of passengers including driver)
16plus
Van (By Number of passengers including driver) 1-8
9-15
Limousines (By Number of passengers including driver)
1-8 9-15
16plus
COMMODITIES |
Commodities transported:
Do you transport hazardous materials? No
Yes
If Yes, do you transport them in: Cargo Tanks
Packages
If yes, list Hazard Class or division of all
hazardous materials transported:
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List the
name of sole proprietor, a partner or an officer of
company and title:
Check here
if
you are an individual or partnership.
If a corporation, State Of Incorporation:
Date Of
Incorporation:
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SECTION B:
If filing as an Individual, complete this
section:
Full Legal Name:
Social Security Number:
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