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.)

Address

Company Phone Number*

Contact Phone Number*

S Corporation?*
—Please choose an option—YesNoDon't Know

IFTA Registration*
—Please choose an option—YesNo

Number of IFTA decals needed

Hazmat?*
—Please choose an option—YesNo

Canada permits?*
—Please choose an option—YesNo

Type of trailer used*
Dry vanReeferFlat bedCar haulerTanker

State permits needed*
KentuckyNew MexicoNew YorkOregonNone

Help with insurance?*
—Please choose an option—YesNoMaybe

Illinois Intrastate Authority*
—Please choose an option—YesNoMaybe

Truck/trailer description (year, make, vin#)

I am aware that by submitting this form I give my permission to DL FREIGHT Inc to process my application for a Motor Carrier Authority as well as any permits needed to complete the process.*
Yes

Additional Notes (optional)