1.  Farmer with farm-plated truck crossing state lines

1. Farmer with farm-plated truck crossing state lines

Enter 'Yes' if you are a farmer with a farm-plate on your truck or tractor and you will be hauling your own loads (not for pay) across state lines. You will need a USDOT number, register for IFTA fuel tax (if your truck or tractor and trailer combination weigh over 26,000-lbs), complete an MCS-150A form and register for UCR. We can help you. Answer 'Yes' in the box below, complete the following form and then contact us.

2.  Farmer being paid to haul loads across state lines

2. Farmer being paid to haul loads across state lines

Enter 'Yes' if you are a farmer and you are going to haul loads across state lines for pay. If your truck, or tractor and trailer are more than 26,000-lbs, you will need a USDOT number, an IRP license plate, register for IFTA fuel tax, obtain Motor Carrier (MC) operating authority if the loads require MC authority, complete the Federal MCS-150A form and register for UCR. If you haul grain, you will not need MC Authority. If you have questions, call us.

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

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

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

4.  Maximum Extent of Operations:  Interstate

4. Maximum Extent of Operations: Interstate

Enter 'Yes' if you will be crossing state lines

5.  Yes, I Carry Hazardous Materials

5. Yes, I Carry Hazardous Materials

If you are going to haul your own hazardous materials across state lines, contact us !!! If you will not be carrying any hazardous materials across state lines requiring placarding, leave the box blank

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 placarding across state lines.

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 none of your trucks have a Gross Vehicle Weight Rating (GVWR) of 10,000-lbs or more stamped on the door jamb, 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 Gross Vehicle Weight Rating of 10,001-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 above 10,000-lbs, enter 'Yes' - otherwise leave the box blank

9.  Name of Company Official or Owner

9. Name of Company Official or Owner

Please enter your 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 the 'Owner'. If the company is a Corporation or an LLC, enter the full name of the Corporation or LLC followed by 'Inc.' or 'LLC'

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

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

If the legal name is your personal name and you are not using a Corporate name or an 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.

13.  Physical Address - Street

13. Physical Address - Street

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

14.  City

14. City


15.  County

15. County


16.  State

16. State

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

17.  Zip Code

17. Zip Code


18.  Phone Number

18. Phone Number


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 different street address to receive mail

22.  City

22. City


23.  State

23. State

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

24.  Zip Code

24. Zip Code


25.  EIN Federal ID Number

25. EIN Federal ID Number

If your truck is part of the farm business, and you have a Federal ID Number, please enter the number in the box below. If the truck is separate from the farm business, enter the Federal ID Number of the trucking business below. 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 a Federal ID Number for the 2290 Federal Highway Use Tax - Call us.

26.  Social Security Number

26. Social Security Number

If your business is a Corporation or an LLC, we will not need a Social Security Number. If you are not a Corporation or an LLC, we will need the number

27.  E-Mail Address

27. E-Mail Address


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Greatlakes@gls.comcastbiz.net

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