Unified Carrier Registration 2024

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

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

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Upload Vehicle Title(s)

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If Other, please specify

USDOT Number

MC Number (opcional)

Officer / Member Full Name

Identification Number (Passport or Driver’s License)

Please upload Government ID

Choose File

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.

First Name

Last Name