1.  Private Commercial Carrier - HAZARDOUS MATERIALS

1. Private Commercial Carrier - HAZARDOUS MATERIALS

Enter 'Yes' if you need a USDOT Number as a Private Commercial Carrier, not-for-hire, hauling your own Hazardous Materials requiring placarding

2.  The State (or the main state) your Business is located in

2. The State (or the main state) your Business is located in

Please spell out the entire name of your state and do not abbreviate the state name

3.  Maximum Extent of Operations

3. Maximum Extent of Operations

If you will be crossing state lines, enter 'Yes' in the box. If you are going to remain in the estate and not cross state lines, leave the box blank

4.  Intrastate Operation

4. Intrastate Operation

If you are not going to cross state lines and will remain in the state with your truck or trucks, enter 'Yes' - otherwise leave the box blank

5.  Yes, I carry Hazardous Materials

5. Yes, I carry Hazardous Materials

Enter 'Yes' as you will be carrying Hazardous Materials

6.  Hazardous Materials Safety Permit Materials Carried

6. Hazardous Materials Safety Permit Materials Carried

Enter 'Yes' if you will be hauling Highway Route Controlled Quantities (HRCQ) of Radioactive materials - otherwise leave the box blank

7.  More than 55 lbs of Div 1.1, 1.2, 1.3, or Div 1.5

7. More than 55 lbs of Div 1.1, 1.2, 1.3, or Div 1.5

Enter 'Yes' if you will be carrying more than 25 Kilograms (55 lbs) of a Division 1.1, 1.2 or 1.3, or a quantity of Division 1.5 material that requires placarding. Otherwise leave the box blank.

8.  Material Piosinous by Inhalation (TIH)

8. Material Piosinous by Inhalation (TIH)

For materials that meet the definition of "materials poisonous by inhalation" (TIH) as defined in 49 CFR 171.8; More than 1 liter (1.08 quarts) per package of a material meeting the definition of a Hazard Zone A TIH material, a material meeting the definition of a Hazard Zone B TIH material in a bulk package (capacity greater than 450 liters (119 gallons), or a material meeting the definition of a Hazard Zone C or D TIH material in a bulk packaging that has a capacity greater than 3,500 gals

9.  Shipments of Compressed or Refrigerated liquid Methane or ...

9. Shipments of Compressed or Refrigerated liquid Methane or ...

Enter 'Yes' if you will be hauling shipments of compressed or refrigerated liquid methane or liquefied natural gas with a methane content of at least 85% in a bulk packaging that has a capacity greater than 13,248 liters (3,500 gallons)

10.  All trucks with a Gross Vehicle Weight Rating of less than 10,000-lbs

10. All trucks with a Gross Vehicle Weight Rating of less than 10,000-lbs

If you need a USDOT Number and none of your trucks have a Gross Vehicle Weight Rating (GVWR) of 10,000-lbs or more stamped on the door jamb, enter 'Yes' - otherwise leave the box blank.

11.  One or more trucks have a GVWR of 10,000-lbs or more

11. One or more trucks have a GVWR of 10,000-lbs or more

If your truck, or if one of your trucks has a Gross Vehicle Weight Rating (GVWR) of 10,000-lbs or more, OR, if you will be pulling a trailer where the COMBINED Gross Vehicle Weight Ratings of both the truck and the trailer are 10,000-lbs or more, enter 'Yes' - otherwise leave the box blank

12.  Name of Company Official or Owner

12. Name of Company Official or Owner

Please enter your first name, middle initial and last name

13.  Title of Company Official, or Owner

13. Title of Company Official, or Owner

If your company is a Corporation, enter 'President' or 'Secretary Treasurer'. If your company is an LLC, enter 'Member'. If you are the owner and the business is neither a Corporation nor an LLC, enter 'Owner'

14.  Legal Name

14. Legal Name

Enter your personal name if you are the owner. If the company is Corporation or LLC, enter the full name of the Corporation or LLC followed by 'Inc.' or 'LLC'

15.  'Doing Business As' or d/b/a name

15. 'Doing Business As' or d/b/a name

If the legal name is your personal name and you are not using a Corporate name or LLC name, you can use a 'Doing Business As', or d/b/a name. If you want to use a d/b/a name, the d/b/a name will follow your personal name such as John Smith d/b/a Smith Transport, or John Smith d/b/a JS Transport. If you want to use a d/b/a name, do not enter your personal name in the box below, type in only the d/b/a name you would like to use for your business.

16.  Physical Address - Street

16. Physical Address - Street

In addition to your physical address, if you have a separate mailing address, you can enter the mailing address in box # 24 below. But, we still need your physical address to be entered in this box

17.  City

17. City


18.  County

18. County


19.  State

19. State

Please spell out the entire name of your state and do not abbreviate the state name

20.  Zip Code

20. Zip Code


21.  Phone Number

21. Phone Number


22.  Cell Phone #

22. Cell Phone #


23.  Fax Number

23. Fax Number


24.  Mailing Address - P.O. Box, or Different Street Address

24. Mailing Address - P.O. Box, or Different Street Address


25.  City

25. City


26.  County

26. County


27.  State

27. State

Please spell out the entire name of your state and do not abbreviate the state name

28.  Zip Code

28. Zip Code


29.  EIN Federal ID Number

29. EIN Federal ID Number

If you have a Federal ID Number and know this number, please enter the number in the box below. If you are a Corporation or an LLC, we will need this number. The number is a two digit number followed by a dash and then seven digits (12-3456789). If you are a Corporation or an LLC and you do not have this Federal ID Number, call us and we can apply for a number. If your truck, or tractor and trailer combination is over 54,000-lbs loaded, you will need a Federal ID Number for your 2290 - Call us.

30.  Social Security Number

30. Social Security Number

Your Social Security Number is not needed if you are a Corporation or an LLC, but we will need this number if you are 'Owner'

31.  E-Mail Address

31. E-Mail Address


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Greatlakes@gls.comcastbiz.net

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