UCR - Unified Carrier Registration Form

  • Carrier Info Confirm Your Official Representative
  • Registration Details Number of registered vehicles
  • Payment Info Pay to Complete Registration
Carrier Information
Step 1 - 3
Who is creating this registration?
Intrastate Notice
Mailing Address*
Registration Details
Step 2 - 3
Are you updating any of the company's Operations Classification?
Carrier Classification

 

 

 

 

 
Vehicles
Order Details
Vehicle Total :
Total Cost :
Payment Information
Step 3 - 3
Order Details
Vehicle Total :
Total Cost :
Billing Address
I certify that I am the authorized holder and signer of the credit card reference above. I certify that all information above is complete and accurate.
I hereby authorize collection of payment for all charges as indicated above. Charges may not exceed the amount listed above in the “TOTAL COST” field. I understand this is only for up to this amount on the date listed below in the "DATE SIGNED" field. If additional charges are going to be authorized a new form will have to be completed.
The “TOTAL COST” includes all Federal, State and Local Government fees.
I hereby, acknowledge and agree that after the charges are authorized a DOT Operating Authority agent is assigned in 15 minutes to run the order. Once the agent is assigned the charges become non-refundable.

Name of person signing

Title

Official Representative

Date signed

03/20/2023

Signature

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