USDOT Number Registration – MASERVIGESTION CORPORATION

USDOT Number Registration Form

Please complete the following information.

First Name

Last Name

Email Address

Contact Phone

Legal Business Name

Please upload Certificate of Formation / Incorporation

Choose File

Doing Business As (DBA) – If Applicable

EIN / FEIN

Entity Type

Please upload IRS EIN / FEIN Confirmation Letter (CP 575 o 147C)

Choose File

Business Address

Address Line 1

City

State

Zip Code

State of Formation

Will you operate Commercial Motor Vehicles (CMV) with a GVWR over 10,001 lbs?

Yes

Vehicle Information

Vehicle VIN #	Vehicle ID #	Maximum Vehicle GVWR (Gross Vehicle Weight Rating in lbs)

Please upload Vehicle Registration

Choose File

Upload Vehicle Title(s)

Choose File

If Other, please specify

Officer / Member Full Name

NAME

TITLE

SSN/ TIN #

ADRESS

TELEPHONE #

Please upload Government ID

Choose File

Base State

Authorized Person Name

Authorized Person Title

Owner

Member

Manager

President

Authorization Consent

I certify that the information provided is accurate and I authorize MASERVIGESTION CORPORATION to prepare and submit filings on my behalf with IRS, state agencies, and other authorities as required.

First Name

Last Name