DOT + MC -

Form Filing Instructions – DOT & MC Authority

Please complete this form accurately. After submission, a professional will contact you. Once processed, you’ll receive an email with your documents.

New Authority Registration Form

Name for your LLC

Please enter the official name of your LLC.

89f04edc-b78b-4528-a1c6-c795930f3b38

Purpose of authority

Briefly describe the purpose of obtaining authority.

This field is required.

Number of Owners

Enter the total number of owners for the LLC.

This field is required.

Business Address

Provide the physical address of the business.

Address Line 1

89f04edc-b78b-4528-a1c6-c795930f3b38

Address Line 2

89f04edc-b78b-4528-a1c6-c795930f3b38

City

89f04edc-b78b-4528-a1c6-c795930f3b38

State

89f04edc-b78b-4528-a1c6-c795930f3b38

Postal Code

89f04edc-b78b-4528-a1c6-c795930f3b38

Country

Mailing Address

If different from business address, provide the mailing address.

Address Line 1

89f04edc-b78b-4528-a1c6-c795930f3b38

Address Line 2

89f04edc-b78b-4528-a1c6-c795930f3b38

City

89f04edc-b78b-4528-a1c6-c795930f3b38

State

89f04edc-b78b-4528-a1c6-c795930f3b38

Postal Code

89f04edc-b78b-4528-a1c6-c795930f3b38

Country

Responsible person for business/LLC

Enter the name of the responsible person for the LLC.

89f04edc-b78b-4528-a1c6-c795930f3b38

First Name

Enter the first name of the responsible person.

89f04edc-b78b-4528-a1c6-c795930f3b38

Last Name

Enter the last name of the responsible person.

89f04edc-b78b-4528-a1c6-c795930f3b38

Address

Enter the address of the responsible person.

Address Line 1

89f04edc-b78b-4528-a1c6-c795930f3b38

Address Line 2

89f04edc-b78b-4528-a1c6-c795930f3b38

City

89f04edc-b78b-4528-a1c6-c795930f3b38

State

89f04edc-b78b-4528-a1c6-c795930f3b38

Postal Code

89f04edc-b78b-4528-a1c6-c795930f3b38

Country

Phone Number

Enter a valid phone number for the responsible person.

This field is required.

Enter a valid email address for correspondence.

This field is required.

Who is filing for this business?

Provide the name of the person filing for the business.

89f04edc-b78b-4528-a1c6-c795930f3b38

Authorization Statement

Please confirm your authorization statement as required.

This field is required.

Full Name

Enter your full name as the signer.

89f04edc-b78b-4528-a1c6-c795930f3b38