Operating Authority Application FID#SS#Type of Authority*Contract CarrierCommon CarrierProperty Broker(Each additional Authority requested will require an additional $300.00 fee)Type of BusinessSole ProprietorPartnershipCorporationLLCName First Last Your Company Name (if any):Contact PersonTitlePhysical Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Mailing Address (If Different) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Officers, Partners or MembersName First Last TitleSS#Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Name First Last SS#Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Company InformationMC Number of Current ICC or FHWA AuthorityDo you currently hold a US DOT Carrier NumberYesNoNot SureIf so, what is your account numberHave you received a US DOT Safety Rating?YesNoNot SureCommodities that your Company will Transport: General Commodities Including Bulk (For General Commodity Authority Including Bulk your firm must have $750,000 in Public Liability insurance and $10,000 in Cargo) Hazardous Materials in Bulk or that are Classified in an Extremely Volital Category (For this Extremely Volital and/or Hazardous Material in Bulk Authority your comapny must have 5 million in Public Liability Insurance and $10,000 in Cargo) Household Goods Carrier Passenger Authority Please check all that applyLiability InsuranceCompany NameAgent's NamePhone NumberFax NumberOnce you submit the form we will contact you no later then the next business day to verify the information and for the payment.Captcha