House Bill 225 - Company Registration
	Please click here to review the Online Registration Instructions, before filling out the online application below.
	Applicant's Legal Name		(If DBA as carrier listed below) Enter Legal Name
	Account Type		Company Account         Business Name   Driver Account         Driver License # Chars and Digits (0-9) only
	Business Address
	Street		Enter street address
	City		Enter city
	State		Enter state
	Zip Code		Enter zip
	County		Appling Athens- Clarke Atkinson Augusta-Richmond Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Columbus-Muscogee Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emmanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Out-of-State Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Putnum Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tatnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Select County
	Mailing Address		Check this box if Business Address and Mailing Address are the same.
	Street
	City
	State
	Zip Code
	County		Appling Athens- Clarke Atkinson Augusta-Richmond Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Columbus-Muscogee Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emmanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Out-of-State Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Putnum Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tatnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth
	Telephone Number
	Cell Phone Number
	Fax Number
	Email Address		Enter Email Invalid Email Format
	(Retype Email Address)		Retype Email Invalid Email Format
	The undersigned understands that the electronic signing and sealing of documents is governed by Georgia law specifically, but not limited to, Chapter 12 of Title 10 of the Official Code of Georgia. By executing this affidavit, the undersigned verifies its compliance with the requirements of Article 3 of Chapter 1 of Title 40 of the Official Code of Georgia and states affirmatively that the individual or company is engaged in passenger carrier services. I declare, to the best of my knowledge, the information herein is true, accurate, and complete. By electronically signing this document, you are not only agreeing to the foregoing but certifying that any willful falsification of any information contained herein is grounds for suspension, revocation, or cancellation of license(s) and/or criminal prosecution.
	I agree.
	By clicking Submit you are acknowledging that your operation qualifies for one or more services under this registration and that the registration fee is nonrefundable.