Forms available online at www.TxDMV.gov Page 1 of 2
Certification Regarding Agreement to
Transport Super Heavy Load(s)
Shipper Information
Shipper Name
Mailing Address
Phone Number
City
State
Zip
Load Information
Load Description
Number of Loads (same description, dimensions, and weight)*
Will there be additional loads* related to this contract?
Yes
No
If yes, how many loads?
*For additional loads with different descriptions, dimensions and/or weight, provide the load information using the attached page.
Attach additional pages as needed. The attached page(s) are incorporated as if written and copied herein.
Width
Height
Length Unit Weight
Movement Information
Starting Address/Location
Destination Address/Location
Proposed Movement Date
Transport Company Information The following company will transport or haul described load.
Transport Company Name
Phone Number
Zip
State
City
Mailing Address
Certification
Under penalty of perjury, I certify that I am authorized to make this certification and that the information provided in this form is
complete, true, and correct. I certify that there is one or more current agreements between the shipper and the transport company or
logistics company to transport the load(s) described herein. I understand the Texas Department of Motor Vehicles may investigate and
impose an administrative penalty if I provide false information on this form, as authorized by Transportation Code, Section 623.271.
Shipper/Logistics Company:
Signature
Printed Name
Title
Date
Transport Company:
Signature
Printed Name
Title
Date
**If the transport company signed the contract with the shipper to transport the load(s) described in this form, the transport company
must sign this form. If a logistics company signed the contract with the shipper to arrange for the transportation of the load(s) described
in this form, the logistics company must sign this form.
MCD-305 SH CERT (Rev. 07/17)
Companies transporting their own equipment may leave the shipper information and
shipper/logistics company certification fields blank.
