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Application for ITA Membership as a Motor Carrier
*Note:
All fields marked with an asterisk (*) are required.
*
Company Name
Company Name is required.
Primary Contact
Primary Contact Title
*
Email Address
Email Address is required.
*
Full Mailing Address
Full Mailing Address is required.
Company Phone Number
Please format as phone (555) 555-5555
Primary Contact Cell phone
Please format as phone (555) 555-5555
Website
DOT number
Total Miles driven, in Idaho, in the previous year.
*
Idaho Mileage
Idaho Mileage is required.
Number of trucks in your fleet.
Power Units
Check the Conference that most closely fits your company
Highway Carrier
Resource Transporter
Specialized Transport
Safety Director Name
Safety Director Email
Safety Director Phone
Please format as phone (555) 555-5555
Other Contact Name
Other contact Title
Other Contact Email Address
I hereby apply for membership in the Idaho Trucking Association. I agree to abide by the Association by-laws. Typing my name constitutes my electronic signature.
Agreement
Required