Starter Compliance form – MASERVIGESTION CORPORATION

Starter Compliance Plan

Please complete the following information.

First Name

Last Name

Email Address

Contact Phone

Legal Business Name

Please upload Certificate of Formation / Incorporation

Choose File

Entity Type

Doing Business As (DBA) – If Applicable

EIN / FEIN

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

USDOT Number

Please upload USDOT Confirmation

Choose File

Officer / Member Full Name

SSN / ITIN ( 999-99-9999)

Date of Birth

Identification Number (Passport or Driver’s License)

Please upload Government ID

Choose File

MC Number (opcional)

Please upload MC Authority Letter ( If Applicable )

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.