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Georgia Intrastate Motor Carrier Registration (GIMC) - Renew
FirstName
Last Name
Legal Name
Doing Business Under The Following Name(DBA)
MCA Number
USDOT Number
Registration Year
Corporate Officer(s)
Current Officers
Additional Corporate Officer(s)
First Name
Last Name
Street
City
State
Zip
First name is required
Last name is required
VIN Number(s)
Add Vehicle VIN number
VIN number
(17 chars. If the VIN is not 17 chars long, add leading zeros.)
VIN number is required
17 chars long(only alphanumeric)
Total Vehicle
(Num of Vehicle X $5.00 per vehicle) Renew fee due $
Certification
The above described applicant hereby applies for the registration of Georgia Intrastate Motor Carrier of the vehicle or vehicles which it operates within or through the borders of Georgia during the period for which such registration is effective. The operation of such vehicle or vehicles shall be accordance with O.C.G.A ยง 40-2-140. I, the undersigned, under penalty for false statement, certify that the above information is true and correct and that I am authorize to execute and file this document on behalf of the applicant.
Name of Authorized Representative
Date
Title
Enter representative name