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ORDER YOUR AUTHORITY

GOLD PACKAGE MOTOR CARRIER AUTHORITY ORDER FORM

Enter the name of the person or officer that will be the responsible party:

Title or Role

Enter the name of your Company. If you are a "Sole Proprietor" enter your first and last name

Select the Type Company You Are:

Please enter your MAILING Address

State:

Enter Your Physical Address:

State:

Check the type of Authority you want

Vehicle Information

Provide Driver Information

Only choose one catagory for each driver

Tell us if you will be carrying any Hazardous Materials

What kind of Freight will you carry? You may select more than one:

Payment Information

Your credit card will be debited by Fleet Management Strategies a total of the the amount stated below. FMS accepts credit or debit cards. Visa, MasterCard, Discover and American Express.

Billing State:

By submitting this application I certify that the above information is true and correct and I have reviewed and agree to the entire terms and conditions (Terms and Conditions)