Form Mcs 150C PDF Details

If you're a business owner, then you know that there are a lot of forms and applications to fill out in order to keep your company running smoothly. One of the most common forms is the Mcs 150C form, which is used for business registration purposes. In this blog post, we'll provide a brief overview of what the Mcs 150C form is and how it can be used by businesses. We'll also provide some tips on how to complete the form correctly. So if you're looking for information on the Mcs 150C form, then you've come to the right place! Keep reading for more info.

QuestionAnswer
Form NameForm Mcs 150C
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesMCS 150C_060409_wit h508 mcs 150c form

Form Preview Example

OMB NO 2126-0013

Exp. Date:

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0013. Public reporting for this collection of information is estimated to be approximately 20 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590.

U.S. Department of Transportation

Federal Motor Carrier

Safety Administration

INTERMODAL EQUIPMENT PROVIDER IDENTIFICATION REPORT

(Application for U.S. DOT Number)

REASON FOR FILING

(Check Only One)

 

NEW APPLICATION

BIENNIAL UPDATE OR CHANGES

OUT OF BUSINESS NOTIFICATION

1. NAME OF INTERMODAL EQUIPMENT PROVIDER

2. TRADE OR D.B.A (DOING BUSINESS AS) NAME

3.PRINCIPAL STREET ADDRESS/ROUTE NUMBER

4. CITY

5. MAILING ADDRESS (PO BOX)

6. MAILING CITY

7. STATE/PROVINCE

8. ZIP CODE+4

9.COLONIA (MEXICO ONLY)

10. STATE/PROVINCE

11. ZIP CODE+4

12.COLONIA (MEXICO ONLY)

13.PRINCIPAL BUSINESS PHONE NUMBER

14.PRINCIPAL CONTACT CELLULAR PHONE NUMBER

15.PRINCIPAL BUSINESS FAX NUMBER

16. HAVE YOU EVER BEEN ISSUED A U.S. DOT NUMBER BY THE FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION? YES

_ NO

If Yes, enter your U.S. DOT Number __________________________________________________________________________

 

17. DUN & BRADSTREET NO.

18. IRS/TAX ID NO.

EIN#SSN#

19. EMAIL ADDRESS

20.NUMBER OF VEHICLES THAT CAN BE OPERATED IN THE U.S. (TRAILER CHASIS ONLY)

OWNED

LEASED

SERVICED

21. PLEASE ENTER NAME(S) OF SOLE PROPRIETOR(S), OFFICERS OR PARTNERS AND TITLES (e.g PRESIDENT, TREASURER, GENERAL PARTNER, LIMITED PARTNER)

1. __________________________________________________________________

2. ___________________________________________________________________

(Please print Name)

(Please print Name)

22. CERTIFICATION STATEMENT (to be completed by an authorized official)

I, ____________________________________________________, certify that I am familiar with the Federal Motor Carrier Safety Regulations and/or Federal Hazardous materials Regulations

(Please print Name)

Under penalties of perjury, I declare that the information entered on this report is, to the best of my knowledge and belief, true, correct,

 

and complete.

 

 

Signature _________________________________________________

Date ___________________________

Title ___________________________________________

 

 

 

(Please print)

Form MCS-150C (Rev. 03-04-2009)