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Department of RevenueMotor Vehicle Division
1200 Tradport Blvd., Hapeville, GA 30354P.O. Box 161227, Atlanta, GA 30321(404) 675-6135 Fax: (404) 675-6196
Application for Motor Carrier Identification NumberForm MCS-150 GA
(PLEASE NOTE: THIS APPLICA TION IS FOR OPERA TING IN GEORGIA ONLY)
1. Name of Carrier 6. Doing Business As (DBA) Name (If any)
2. Physical Street Address or Route Number 7. Mailing Address (Such as P.O. Box)
3. City 4. State 5. Zip Code (Zip + 4) 8. City 9. State 10. Zip Code (Zip +4)
12. Phone Number
( )11. County 13. Georgia MCA# (If Known~ 14. U.S. DOT# (If updating) 15. ICC MC# (If Known)
(Note: N/A if GA. Only)
16. IRS Tax NumberorssN
EIN
17. E-mail Address 18. Carrier Mileage (Total Fleet Mileage LastCalendar Year)SSN
19. Carrier Operation
A. Georgia Only (Hazardous Materials) B. Georgia Only (Non-Hazardous Materials)
20. Operation Classification
A. Authorized For Hire
B. Exempt For Hire
C. Private (Property)
D.E.
F.
G. U.S. Mail
H Federal Gov!.
I. State Gov!.
J.K.
L.
Local Government
Indian Tribe
Other (Specify):.
Private Passengers (Business)
Private Passengers (Non-Business)
Migrant Workers
21. Cargo Classifications (Please Circle All That Apply)
A. General Cargo G. Building Materials
B. Household Goods H. Mobile Homes
C. Metal Sheet/Coil/Roll I. Machinery
D. Motor Vehicles J. Fresh Produce
E. DriveawayfTowaway K. Liquid/Gases
F. Logs, Poles, Beams, Lumber
DD. OtherL. Intermodal Containers
M. Passengers
N. Oil Field Equipment
O. Livestock
P. Grain, Feed, Hay
Q. Coal/Coke
X. Beverages
Y. Paper Products
Z. Utility
AA. Farm Supplies
BB. Construction
CC. Water Well Drilling
R. Meat
S. Garbage/Refuse
T. U.S. Mail
U. Chemicals
V. Dry Bulk Commodities
W. Refrigerated Food
B
B
NB
NB
B
B
B
NB
NB
NB
22. Hazardous Materials Carrier (Please Circle all thai Apply) B = Bulk packages (e.g. tanks, totes, etc.) NB = In Packages (e.g. drums, boxes, cylinders, etc.)
Explosives Flammable LIquids RadioactiveA. Div.1.1 B NB P. Class 3 B NB DD. Class 7
B. Div.1.2 B NB Q. Class 3A B NB EE. Hwy. Rte. Coni. Qty.
C. Div.1.3 B NB R. Class 3B B NB Corrosives
D. Div.1.4 B NB S. Combustible LIquid B NB FF. Class 8
E. Dlv.1.5 B NB Flammable Solids GG. Class 8A
F.Div.1.6 B NB T.Div.4.1 B NB HH.Class8B
Gases U. Div.4.2 B NB Other
G. Div. 2.1 B NB V. Div.4.3 B NB II. Class 9
H. Div. 2.1 LPG B NB Oxidizers/Organic Peroxides B NB JJ. Elevated Temp. Materials
I. Div. 2.2 B NB W. Dlv. 5.1 B NB KK. Infectious Waste
(Methane) X. Div.5.2 B NB LL. Marine Pollutants
J. Div.2.2 B NB Poisons/Etiologic Agents MM. Haz. Substances (RQ)
K. Div.2.2 B NB Y. Div.6.2 B NB NN. Hazardous Waste
(Ammonia) Z. Div.6.1A B NB OD. ORM.D
L.Div.2.3A B NB AA.Dlv.6.1B B NB
M. Div. 2.3C B NB BB. Div. 6.1 LIquid B NB
N. Div. 2.3C B NB CC. Div. 6.1 Solid B NB
O. Div. 2.3D B
B
B
B
B
B
B
B
NB
NB
NB
NB
NB
NB
NBNB
NB
NB
NB
23. Equipment TotalIStraight Trucks
TotalTruck Tractors
Total TotalTrailers HazMat Cargo
Tank Trucks
Passengers
Motor Coach School Bus LimousineOwned
Term Leased
Trip Leased
24. Number of Drivers Subject to the Motor Carrier Safety and/or HazMat Regulations
100 Mile Radius
Beyond 100 Mile Radius Total Drivers. Total CDL Drivers