Georgia Intrastate Motor Carrier Registration (GIMC) - Carrier Registration

 
Officer's First Name  
Officer's Last Name  
Business Legal Name  
Doing Business Under The Following Name(DBA)
USDOT Number
Federal Employer Identification Number (EIN)
State Tax Id
Classification - Check all that apply
For Hire   Private   Motor Carrier Transporting Hazardous Materials  
Bus/Motorcoach   Wrecker/Towing Company   Household Goods  
Broker   Leasing Company   Freight Forwarder
Business street  
Business City  
Business State  
Zip Code  
Check this box if Business Address and Mailing Address are the same.
Mailing Street
Mailing City
Mailing State
Zip Code
Telephone Number
Cell Phone Number
Fax Number
Email Address    
(Retype Email Address)