1.  Motor Carrier (For Hire) getting own MC Authority or state authority

1. Motor Carrier (For Hire) getting own MC Authority or state authority

If you are getting your own MC Authority to cross state lines, or state authority to operate in-state, enter 'Yes'

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

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

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

3.  Maximum Extent of Operations:  Interstate

3. Maximum Extent of Operations: Interstate

If you are going to cross state lines, enter 'Yes' - If you are going to remain in-state and not cross cross state lines, 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' - otherwise leave the box blank

5.  Commercial Zone Only, Crossing State Lines

5. Commercial Zone Only, Crossing State Lines

If you are going to operate inside an official Commercial Zone, but haul loads across state lines such as hauling between Hammond / Gary (Indiana) and Chicago (Illinois), enter 'Yes' - otherwise leave the box blank

6.  Yes, I Carry Hazardous Materials

6. 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.

7.  No, I do not carry Hazardous Materials

7. No, I do not carry Hazardous Materials

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

8.  All trucks with a Gross Vehicle Weight Rating of less than 10,000-lbs

8. All trucks with a Gross Vehicle Weight Rating of less than 10,000-lbs

If your your truck does not have, or none of your trucks have a Gross Vehicle Weight Rating (GVWR) of 10,000-lbs or more stamped on the door jamb, or if your truck and trailer do not have Combined Gross Vehicle Weight Ratings of 10,000-lbs or more, enter 'Yes' - otherwise leave the box blank

9.  One or more trucks have a GVWR of 10,000-lbs or more

9. One or more trucks have a GVWR of 10,000-lbs or more

If your truck, or if one of your trucks has a Gross Vehicle Weight Rating (GVWR) of 10,000-lbs or more, OR, if you will be pulling a trailer where the COMBINED Gross Vehicle Weight Ratings of both the truck and the trailer are 10,000-lbs or more, enter 'Yes' - otherwise leave the box blank

10.  Name of Company Official or Owner

10. Name of Company Official or Owner

Please enter First Name, Middle Initial and Last Name

11.  Title of Company Official or Owner

11. Title of Company Official or Owner

Enter 'President' if the company is a Corporation; 'Member' if the company is an LLC; 'Owner' if you are the owner

12.  Legal Name

12. Legal Name

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

13.  'Doing Business As' or d/b/a name

13. 'Doing Business As' or d/b/a name

If the legal name is your personal name and you are not using a Corporate or LLC name, you can use a 'Doing Business As' name, or 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, If you want to use a d/b/a name, do not enter your personal name, only the d/b/a name you would like to use for your business.

14.  Physical Address - Street

14. Physical Address - Street

In addition to your physical address, if you have a separate mailing address, you can enter the mailing address in box # 22 below. But we still need your physical street address to be entered in this box. Enter the street number

15.  City

15. City


16.  County

16. County


17.  State

17. State

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

18.  Zip Code

18. Zip Code


19.  Phone Number

19. Phone Number


20.  Cell Phone #

20. Cell Phone #


21.  Fax Number

21. Fax Number


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

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

P.O. Box or different street address to receive mail

23.  City

23. City


24.  State

24. State


25.  Zip Code

25. Zip Code


26.  EIN Federal ID Number

26. EIN Federal ID Number

If you have a Federal ID Number and know this number, please enter the number 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 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, or tractor and trailer combination is over 54,000-lbs, you will need an EIN for the your 2290 Highway Use Tax - Call us

27.  Social Security Number

27. Social Security Number

A 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'

28.  E-Mail Address

28. E-Mail Address


29.  Do you currently have, or have you ever had MC Authority?

29. Do you currently have, or have you ever had MC Authority?

If you are applying for MC Authority IN ADDITION to this authority application, or if you currently have active MC Authority, or if you had MC Authority which is inactive, enter 'Yes' - If you have never had MC Authority, enter 'No'. Once you have entered your answer, click on 'Submit' and then call us at (765) 742-2610

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Greatlakes@gls.comcastbiz.net

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