1.  Motor Carrier Registrant Leased to, or Leasing to a Trucking Company

1. Motor Carrier Registrant Leased to, or Leasing to a Trucking Company

Enter 'Yes' if you need a USDOT number as a Motor Carrier truck owner leasing on to a trucking company.

2.  The State (or the main state) your Business is located in

2. The State (or the main state) your Business is located in


3.  Maximum Extent of Operations:  Interstate

3. Maximum Extent of Operations: Interstate

If you will be crossing state lines, enter 'Yes" in the box - otherwise leave the box blank

4.  Intrastate Only

4. Intrastate Only

If you are not going to cross state lines and will remain in the state with your truck or trucks, enter 'Yes' below - otherwise leave the box blank

5.  Yes, I carry Hazardous Materials

5. Yes, I carry Hazardous Materials

Enter 'Yes' if you carry Hazardous Materials - otherwise leave the box blank. If you will be carrying Hazardous Materials, call us.

6.  No, I do not carry Hazardous Materials

6. No, I do not carry Hazardous Materials

Enter 'No' if you will not be carrying any hazardous materials requiring placards - otherwise leave the box empty.

7.  All trucks with a Gross Vehicle Weight Rating of 10,000-lbs or under

7. All trucks with a Gross Vehicle Weight Rating of 10,000-lbs or under

If you need a USDOT number and if your truck has, or if your trucks have a Gross Vehicle Weight Rating (GVWR) of 10,000-lbs or less stamped on the door, enter 'Yes' - otherwise leave the box blank

8.  One or more trucks have a GVWR of 10,001-lbs or more

8. One or more trucks have a GVWR of 10,001-lbs or more

If your truck, or if one of your trucks has a GVWR of 10,001-lbs or more, OR, if you will be pulling a trailer where the COMBINED Gross Vehicle Weight Ratings of the truck and the trailer are 10,001-lbs or more, enter 'Yes' - otherwise leave the box blank.

9.  Name of Company Official or Owner

9. Name of Company Official or Owner

Please enter First Name, Middle Initial and Last Name

10.  Title of Company Official or Owner

10. Title of Company Official or Owner

If your company is a Corporation, enter 'President' or 'Secretary Treasurer'; If your company is an LLC, enter 'Member', If Owner, enter 'Owner'

11.  Legal Name

11. Legal Name

Enter your personal name if you are 'Owner'; If the company is a Corporation or an LLC, enter the entire name of the Corporation or LLC followed by 'Inc.' or 'LLC'

12.  d/b/a 'Doing Business As' Name

12. d/b/a 'Doing Business As' Name

Only if your Legal Name is your personal name and not a Corporation or an LLC should you use a d/b/a name. If you want to use a d/b/a name, the d/b/a name will follow your personal name such as John Smith d/b/a Smith Transport, or John Smith d/b/a JS Transport. In the box below, do not enter your personal name, only the d/b/a name you would like to use for your business

13.  Physical Address - Street

13. Physical Address - Street

In addition to your physical address, if you have a mailing address, you can enter the mailing address in box # 21 below. But we still need your physical street address to be entered in this box. Enter your street #

14.  City

14. City


15.  County

15. County


16.  State

16. State

Please spell out the entire name of your state and do not abbreviate the state name

17.  Zip Code

17. Zip Code


18.  Phone #

18. Phone #


19.  Cell Phone #

19. Cell Phone #


20.  Fax Number

20. Fax Number


21.  Mailing Address - P.O. Box or Different Street Address

21. Mailing Address - P.O. Box or Different Street Address

PO Box, or a different street address to receive mail.

22.  City

22. City


23.  State

23. State


24.  Zip Code

24. Zip Code


25.  EIN Federal ID Number

25. EIN Federal ID Number

If you have a Federal ID Number and know this number, please enter in the box below. If you are a Corporation or an LLC, we will need this number. The number is a two digit number followed by a dash and then seven digits (12-3456789). If you are a Corporation or an LLC and you do not have a Federal ID Number, call us and we can apply for a number. If your truck is over 54,000-lbs, or your tractor and trailer combined weights are over 54,000-lbs, you will need to register for the 2290 - Call us

26.  Social Security Number

26. Social Security Number

Your Social Security Number is not needed if your company is a Corporation or an LLC, but we will need this number if you are 'Owner'

27.  E-Mail Address

27. E-Mail Address


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Greatlakes@gls.comcastbiz.net

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