United States Department Of Transportation 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)




















19. IRS/TAX ID NO.

21. COMPANY OPERATION (Check all that apply)


23. OPERATION CLASSIFICATION (Check All that Apply)
24. CARGO CLASSIFICATIONS (Check All that Apply)
25. HAZARDOUS MATERIALS CARRIED OR SHIPPED (Check All that Apply) C-CARRIED S-SHIPPED B(BULK)-IN CARGO TANKS NB(NON-BULK)-IN PACKAGES
A. DIV 1.1 O. DIV 2.3D CC. DIV 6.1SOLID
B. DIV 1.2 P. CLASS 3 DD. CLASS 7
C. DIV 1.3 Q. CLASS 3A EE. HRCQ
D. DIV 1.4 R. CLASS 3B FF. CLASS 8
E. DIV 1.5 S. COMB LIQ GG. CLASS 8A
F. DIV 1.6 T. DIV 4.1 HH. CLASS 8B
G. DIV 2.1 U. DIV 4.2 II. CLASS 9
H. DIV 2.1LPG V. DIV 4.3 JJ. ELEVATED TEMP MAT
I. DIV 2.1(METHANE) W. DIV 5.1 KK. INFECTIOUS WASTE
J. DIV 2.2 X. DIV 5.2 LL. MARINE POLLUTANTS
K. DIV 2.2A (AMMONIA) Y. DIV 6.2 MM. HAZARDOUS SUB(RQ)
L. DIV 2.3A Z. DIV 6.1A NN. HAZARDOUS WASTE
M. DIV 2.3B AA. DIV 6.1B OO. ORM  
N. DIV 2.3C BB. DIV 6.1POISON
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+
27. DRIVER INFORMATION INTERSTATE INTRASTATE
 
28. IS YOUR U.S. DOT NUMBER REGISTRATION CURRENTLY REVOKED BY THE FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION?
    

1.    2.
                                                         (Please print Name)                                                                             (Please print Name)
30. CERTIFICATION STATEMENT (to be completed by an authorized official)

       
                                                                                                                                     (Please print)