UCR Registration

Unified Carrier Registration Form

The Unified Carrier Registration (UCR) form is used by motor carriers, brokers, and freight forwarders to register and pay annual fees based on fleet size. This form is required for entities operating commercial motor vehicles in interstate commerce, while those not engaged in qualifying operations may leave this section optional when referenced in other filings.

GENERAL INFORMATION

USDOT Number

E-Mail Address

Telephone Number

Fax Number

Legal Name

Doing Business under the Following Name (DBA)

Principal Place of Business Street Address (See Instructions)

Principal Place of Business Street Address Principal Business City Principal Business State Principal Business Zip Code

Mailing Street Address

Mailing Street Address Mailing City Mailing State Mailing Zip Code

CLASSIFICATION – Check All That Apply

Motor Carrier

Motor Private Carrier

VEHICLES USED EXCLUSIVELY IN INTRASTATE TRANSPORTATION

MAKE

MODEL / GVWR

LICENSE PLATE

STATE

VIN NUMBER

The above described carrier hereby declares that the following vehicles are used exclusively for intrastate transportation of property, waste, or recyclable material:

CERTIFICATION

Name of Owner or Authorized Representative (Printed)

Date

Signature

Title

UCR Registration

Unified Carrier Registration Form

GENERAL INFORMATION

CERTIFICATION

Us carrier filer

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