Unified Carrier Registration - 2015 Page 2
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1
2Unified Carrier Registration – Year 2015
This form is not
required when filing
Idaho Transportation Department - Motor Carrier Services
online at
PO Box 7129 Boise ID 83707-1129
Phone: 208-334-8611; Fax: 208-334-2006; E-mail:
cvs@itd.idaho.gov
Section 1 – General Information
USDOT Number
MC or MX Number
Freight Forwarder Number
Idaho Account Number (if known)
Telephone Number
Fax Number
E-mail Address
The following information must match the current USDOT record exactly:
Legal Name
Doing Business As (DBA)
Principal Place of Business Street Address
City
State
Zip Code
Mailing Address
City
State
Zip Code
Section 2 – Classification (check all that apply)
Motor Carrier
Motor Private Carrier
Broker*
Freight Forwarder*
Leasing Company*
*Brokers, freight forwarders and leasing companies (not also a motor carrier) skip Section 3 and indicate the $76 fee in Section 4.
Section 3 – Number of Motor Vehicles
(Motor Carrier and Motor Private Carrier only)
Check one box:
a. The number of vehicles shown on Line 1 below match Section 26 of the last reported MCS-150 form.
b. The total number of vehicles shown on Line 1 below were owned and operated for the 12-month period
ending June 30, 2014 (refer to the instructions for mandatory recordkeeping requirements).
Column A – Number of trucks & tractors:
Column B – Number of motor coaches, school or mini buses,
Column C – Total
vans & limousines:
1.
+
=
Subtract the vehicles on Line 1, Column B, with a vehicle capacity of 10 or less passengers,
including driver. You may also subtract those vehicles in Column A used only in intrastate
2.
(
)
transportation (refer to the instructions for mandatory recordkeeping requirements).
You may add any vehicles not shown on Line 1 above that are commercial motor vehicles
operating exclusively in intrastate commerce or those used in commerce to transport
3.
passengers or property for compensation and have a GVWR or GVW of 10,000 pounds or
less, or a passenger capacity of 10 or less, including the driver.
Total Number of Vehicles
(Line 1 Column C minus Line 2 plus Line 3)
4.
Section 4 – Fees
Number of Vehicles
Fee
Number of Vehicles
Fee
Number of Vehicles
Fee
0 – 2
6 – 20
101 – 1,000
$76
$452
$7,511
3 – 5
21 – 100
$227
$1,576
1,001 or more
$73,346
Indicate the fee using the total vehicles on Line 4 of Section 3.
Fees Due
Payment (in U.S. funds) can be made by check payable to “State of Idaho,” by MasterCard or
$
VISA (include cardholder name, card number & expiration date).
Section 5 – Certification
I, the undersigned, under penalty for false statement, certify that the above information is true and correct and that
I am authorized to execute and file this document on behalf of the applicant.
Printed Name of Owner or Authorized Representative
Title
Signature
Date
UCR-9/14
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