Intrastate Authority Application

Intrastate Authority Application
Name*

First NameLast Name
Co-Owner's Name (if applicable):

First NameLast Name
Company Name *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number:*

Area CodePhone Number
Fax Number:

Area CodePhone Number
Email*
example@example.com
FEIN: (Federal Employer Identification Number)*
SS-4 (This is a copy of your Federal Employer Identification Number from the IRS)

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How Many Trucks?*
How Many Trailers?*
How many CDL drivers?*
How many Non CDL Drivers?*
What will you be hauling?*
Hauling Hazmat?*
Will your company operate over 26,000 pounds in gross weight? (This includes truck, trailer, and loaded weight?)*
Do you have a DOT number?*
DOT Number:*
If you do not have a DOT # already, type NEED
Login.gov Username (if available)
Login.gov Password (if available)
Please upload GIMC affidavit.*

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Please submit a copy of the owner's driver's license (Front & Back). *

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Please upload a list of ALL VINs that will be running under the company's intrastate authority. *

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Please upload the Power of Attorney.*

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How did you hear about us?*

OnlineTruck PaperOtherReferral
You may pay with a credit card, ACH, Fleet one check, EFS check, T-Check or Comcheck. If you are paying with a credit card there is a 4% convenience fee. There will be a $25.00 bank fee for returned checks. If you have any questions, please contact our authorities department at (877) 233-9014 extension 1 or by fax at (770) 228-4242.
The Financial Integrity Group -410 East Taylor Street Suite G, Griffin, Ga 30223

authorities@tfig.org
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