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(Application for USDOT Number)

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OMB No. 2126-0013
U.S. Department of Transportation
Federal Motor Carrier
Safety Administration
REASON FOR FILING (Mark only one)
1. NAME OF MOTOR CARRIER 2. TRADE OR D.B.A. (DOING BUSINESS AS) NAME
3. PRINCIPAL ADDRESS
4. CITY 5. STATE/PROVINCE 6. ZIP CODE+4 7. COLONIA (MEXICO ONLY)
8. MAILING ADDRESS 9. CITY 10. STATE/PROVINCE 11. ZIP CODE+4 12. COLONIA (MEXICO ONLY)
13. PRINCIPAL BUSINESS PHONE NUMBER 14. PRINCIPAL CONTACT CELL PHONE NUMBER 15. PRINCIPAL BUSINESS FAX NUMBER
16. USDOT NO.
17. MC OR MX NO.
18. DUN & BRADSTREET NO. 19. IRS/TAX ID NO.
EIN SSN
20. INTERNET E-MAIL ADDRESS
21. CARRIER MILEAGE (to nearest 10,000 miles for last calender year)
YEAR
INTERSTATE TOTAL CDL DRIVERS
27. DRIVER INFORMATION
Within 100-Mile Radius
Beyond 100-Mile Radius
28. IS YOUR USDOT NUMBER REGISTRATION CURRENTLY REVOKED BY THE FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION?
If Yes, enter your USDOT Number. ____________________________________________________________
29. PLEASE ENTER NAME(S) OF SOLE PROPRIETOR(S), OFFICERS OR PARTNERS AND TITLES (e.g. president, treasurer, general partner, limited partner)
I, , certify that I am familiar with the Federal Motor Carrier Safety Regulations and/or Federal Hazardous Materials Regulations.
Under penalties of perjury, I declare that the information entered on this report is, to the best of my knowledge and belief, tr u e,
corr ect, and complete.
Signature ____________________________________________ Date _______________________________ Title ______________________________________________
(Please print)
1. 2.
Yes N o
NEW APPLICATION BIENNIAL UPDATE OR CHANGES OUT OF BUSINESS NOTIFICATION REAPPLICATION (AFTER REVOCATION OF NEW ENTRANT)
Public reporting for this collection of information is estimated to be 20 minutes per response, including the time for reviewing instructions and completing and reviewing the collection of information. All responses to this collection of information are mandatory, and will be
provided confidentiality to the extent allowed by the Freedom of Information Act (FOIA). Not withstanding any other provision of law, no person is 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 valid OMB Control Number for this information collection is 2126-0013. 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-MMI, U.S. Department of Transportation, Washington, D.C. 20590.
(Application for USDOT Number)
Form MCS-150 (Revised: 6/12/2007)
A. Interstate Carrier B. Intrastate Hazmat Carrier C. Intrastate Non-Hazmat Carrier D. Interstate Hazmat Shipper E. Intrastate Hazmat Shipper
F. Vehicle Registrant Only
A.
B.
C.
Authorized For-Hire
Exempt For-Hire
Private Property
D.
E.
F.
Private Passengers (Business)
Private Passengers (Non-Business)
Migrant
G.
H.
I.
U. S. Mail
Federal Government
State Government
J.
K.
L.
Local Government
Indian Tribe
Other
22. COMPANY OPERATION (Mark all that apply)
23. OPERATION CLASSIFICATION (Mark all that apply)
24. CARGO CLASSIFICATIONS (Mark all that apply)
TERM LEASED
TRIP LEASED
1-8
9-15
16+
9-15
16+
.
25. HAZARDOUS MATERIALS (CARRIER OR SHIPPER) (Mark all that apply)
(C) CARRIER (S) SHIPPER (B) BULK – IN CARGO TANKS (NB) NON-BULK – IN PACKAGES
A. DIV 1.1
B. DIV 1.2
C. DIV 1.3
D. DIV 1.4
E. DIV 1.5
F. DIV 1.6
G. DIV 2.1 (Flam. Gas)
H. DIV 2.1 LPG
I. DIV 2.1 (Methane)
J. DIV 2.2
K. DIV 2.2D (Ammonia)
L. DIV 2.3A
M. DIV 2.3B
N. DIV 2.3C
O. DIV 2.3D
P. Class 3
Q. Class 3A
R. Class 3B
S. COMB LIQ
T. DIV 4.1
C S B NB C S B NB C S B NB
C S B NB
U. DIV 4.2
V. DIV 4.3
W. DIV 5.1
X. DIV 5.2
Y. DIV 6.2
Z. DIV 6.1A
AA. DIV 6.1B
BB. DIV 6.1 POISON
CC. DIV 6.1 SOLID
DD. CLASS 7
26. NUMBER OF VEHICLES THAT WILL BE OPERATED IN THE U.S.
Straight
Truck
Trailers
Hazmat Cargo
Hazmat Cargo
Motor-
Trucks
Tractors
Tank Trucks
Tank Trailers
coach
Number of vehicles carrying number of passengers (including the driver)
16+
1-8
9-15
16+
OWNED
INTRASTATE
TOTAL DRIVERS
Expiration Date: 1/13/2008
School Bus Mini-bus
Passenger
Van
Limousine
GG.
OO.
EE. HRCQ
FF. CLASS 8
CLASS 8A
HH. CLASS 8B
II. CLASS 9
JJ. ELEVATED TEMP MAT.
KK. INFECTIOUS WASTE
LL. MARINE POLLUTANTS
MM. HAZARDOUS SUB (RQ)
NN. HAZARDOUS WASTE
ORM
30. CERTIFICATION STATEMENT (to be completed by authorized ocial)
A. GENERAL FREIGHT G. BUILDING MATERIALS M. PASSENGERS S. GARBAGE, REFUSE, TRASH Y. PAPER PRODUCT
B. HOUSEHOLD GOODS H. MOBILE HOMES N. OIL FIELD EQUIPMENT T. U.S.MAIL Z. UTILITY
C. METAL:SHEETS, COILS, ROLLS I. MACHINERY, LARGE OBJECTS O. LIVESTOCK U. CHEMICALS AA. FARM SUPPLIES
D. MOTOR VEHICLES J. FRESH PRODUCE P. GRAIN, FEED, HAY V. COMMODITIES DRY BULK BB. CONSTRUCTION
E. DRIVE AWAY/TOWAWAY K. LIQUIDS/GASES Q. COAL/COKE W. REFRIGERATED FOOD CC. WATER WELL
F. LOGS, POLES, BEAMS, LUMBER L. INTERMODAL CONT. R. MEAT X. BEVERAGES DD. OTHER
ABC Sample Company Name
1234 Main Street
Anywhere
GA
30060
30060
GA
Anywhere
00000000
000000
0000000000
2007
■
■
■
■
■
10
15
20
12
0
0
18
30
30
David Smith
Jeff Winters
David Smith
4/22/2008
Fleet President
Filing Paper by Mail.
o Submit all required MCS and/or OP forms together.
o Once the application is completed, FMCSA suggests making a copy for the company’s files.
o Mailed applications, on average, take four to six weeks processing time.
o Notification of USDOT Number will be sent to the mailing address provided in items 8-11 of submitted MCS-
150 or MCS-150B form.
o Mail completed application form(s) to:
Federal Motor Carrier Safety Administration
Attention: USDOT Number Application
1200 New Jersey Avenue SE
Washington, DC 20590
Note: Applications that are incomplete, unreadable, or unsigned will be rejected and returned via mail, delaying
the receipt of the company’s USDOT Number.
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(Application for USDOT Number)

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Completed 25 January 2021

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