Your Name (required)

Your Email Address (required)

Your Phone Number (required)

Company Name*

President/Owner's Name (if a corporation or LLC)*

Title (President, Owner, Manager, etc.)

Current Address

Phone Number*

MC (Motor Carrier) Number*

DOT Number*

Number of trucks hauling freight under this authority number.*

I am aware that by submitting this form I give my permission to DL FREIGHT Inc to complete the UCR Registration application on my behalf. *
Yes

Additional Notes (optional)