MOTOR CARRIER IDENTIFICATION REPORT (Application for U.S. DOT Number)
U.S. Department of Transportation Federal Motor Carrier Safety Administration
REASON FOR FILING (Check Only One) NEW APPLICATION BIENNIAL UPDATE OR CHANGES OUT OF BUSINESS NOTIFICATION REAPPLICATION (AFTER REVOCATION OF NEW ENTRANT)
1. NAME OF MOTOR CARRIER		2. TRADE OR D.B.A. (DOING BUSINESS AS) NAME
3. PRINCIPAL STREET ADDRESS/ROUTE NUMBER	4. CITY	5. MAILING ADDRESS (P O BOX)	6. MAILING CITY

7. STATE/PROVINCE	8. ZIP CODE+4	9. COLONIA (MEXICO ONLY)	10. MAILING STATE/PROVINCE	11. MAILING ZIP CODE+4	12. MAILING COLONIA (MEXICO ONLY)
13. PRINCIPAL BUSINESS PHONE NUMBER		14. PRINCIPAL CONTACT CELLULAR NUMBER		15. PRINCIPAL BUSINESS FAX NUMBER
16. USDOT NO.	17. MC OR MX NO.	18. DUN & BRADSTREET NO.	19. IRS/TAX ID NO. EIN# SSN#		20. INTERNET E-MAIL ADDRESS
21. COMPANY OPERATION (Check all that apply) A. Interstate Carrier B. Intrastate Hazmat Carrier C. Intrastate Non-Hazmat Carrier D. Interstate Shipper E. Intrastate Shipper F. Vehicle Registrant Only
22. CARRIER MILEAGE (to nearest 10, 000 miles for Last Calendar Year)			YEAR
23. OPERATION CLASSIFICATION (Check All that Apply)
A. Authorized For-Hire D. Private Passengers (Business) G. U.S. Mail J. Local Government B. Exempt For-Hire E. Private Passengers (Non-Business) H. Federal Government K. Indian Tribe C. Private Property F. Migrant I. State Government L. Other
24. CARGO CLASSIFICATIONS (Check All that Apply)
A. GENERAL FREIGHT I. MACHINERY,LARGE OBJECTS Q. COAL/COKE Y. PAPER PRODUCTS B. HOUSEHOLD GOODS J. FRESH PRODUCE R. MEAT Z. UTILITY C. METAL:SHEETS,COIL,ROLLS K. LIQUIDS/GASES S. GARBAGE,REFUSE,TRASH AA. FARM SUPPLIES D. MOTOR VEHICLES L. INTERMODAL CONT. T. U.S. MAIL BB. CONSTRUCTION E. DRIVE AWAY/TOWAWAY M. PASSENGERS U. CHEMICALS CC. WATER WELL F. LOGS,POLES BEAMS,LUMBER N. OIL FIELD EQUIPMENT V. COMMODITIES DRY BULK DD. OTHER G. BUILDING MATERIALS O. LIVESTOCK W. REFRIGERATED FOOD H. MOBILE HOMES P. GRAIN,FEED,HAY X. BEVERAGES

25. HAZARDOUS MATERIALS CARRIED OR SHIPPED (Check All that Apply) C-CARRIED S-SHIPPED B(BULK)-IN CARGO TANKS NB(NON-BULK)-IN PACKAGES C S A. DIV 1.1 B NB C S O. DIV 2.3D B NB C S CC. DIV 6.1SOLID B NB C S B. DIV 1.2 B NB C S P. CLASS 3 B NB C S DD. CLASS 7 B NB C S C. DIV 1.3 B NB C S Q. CLASS 3A B NB C S EE. HRCQ B NB C S D. DIV 1.4 B NB C S R. CLASS 3B B NB C S FF. CLASS 8 B NB C S E. DIV 1.5 B NB C S S. COMB LIQ B NB C S GG. CLASS 8A B NB C S F. DIV 1.6 B NB C S T. DIV 4.1 B NB C S HH. CLASS 8B B NB C S G. DIV 2.1 B NB C S U. DIV 4.2 B NB C S II. CLASS 9 B NB C S H. DIV 2.1LPG B NB C S V. DIV 4.3 B NB C S JJ. ELEVATED TEMP MAT B NB C S I. DIV 2.1(METHANE) B NB C S W. DIV 5.1 B NB C S KK. INFECTIOUS WASTE B NB C S J. DIV 2.2 B NB C S X. DIV 5.2 B NB C S LL. MARINE POLLUTANTS B NB C S K. DIV 2.2A (AMMONIA) B NB C S Y. DIV 6.2 B NB C S MM. HAZARDOUS SUB(RQ) B NB C S L. DIV 2.3A B NB C S Z. DIV 6.1A B NB C S NN. HAZARDOUS WASTE B NB C S M. DIV 2.3B B NB C S AA. DIV 6.1B B NB C S OO. ORM B NB   C S N. DIV 2.3C B NB C S BB. DIV 6.1POISON B NB

26. NUMBER OF VEHICLES THAT CAN BE OPERATED IN THE U.S.

Straight Trucks

Truck Tractors

Trailers

Hazmat Cargo Tank Trucks

Hazmat Cargo Tank Trailers

Motor Coach

School bus

Mini-bus

Van

Limousine

Number of vehicles carrying number of passengers (including the driver) below

1-8

9-15

16+

16+

1-8

9-15

1-8

9-15

16+

OWNED

TERM LEASED

TRIP LEASED

27. DRIVER INFORMATION		INTERSTATE	INTRASTATE		TOTAL DRIVERS		TOTAL CDL DRIVERS
Within 100-Mile Radius
Beyond 100-Mile Radius
28. IS YOUR U.S. DOT NUMBER REGISTRATION CURRENTLY REVOKED BY THE FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION? Yes No     If Yes, enter the U.S. DOT Number.
29. PLEASE ENTER NAME(S) OF SOLE PROPRIETOR(S),OFFICERS OR PARTNERS AND TITLES (e.g. PRESIDENT,TREASURER,GENERAL PARTNER,LIMITED PARTNER) 1.    2.                                                          (Please print Name)                                                                             (Please print Name)
30. CERTIFICATION STATEMENT (to be completed by an authorized official) I,,certify that I am familiar with the Federal Motor Carrier Safety Regulations and/or the Federal Hazardous Materials Regulations.          (Please print Name)       Under penalties of perjury, I declare that the information entered on this report is, to the best of my knowledge and belief, true,                                             correct, and complete. Signature     Date     Title                                                                                                                                      (Please print)