BOC-3

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customerservice@onehourauthority.com

BOC-3

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BOC-3

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:

SOLE PROPRIETOR

LLC

CORPORATION (Give State)

PARTNERSHIP (Give Name)

Please enter your MAILING Address

State:

Enter Your Physical Address:

Check if Physical Address is the same as Mailing Address

State:

Communication Notice

One Hour Authority may send your mobile phone a text to communicate the status of the order. One Hour Authority will only text you in regards to this order. You may "OPT IN" to receive texts from One Hour Authority by checking the box below.

Check to OPT IN to receive texts

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.

Authority Units and Pricing

Check if the name on the credit card is the same as above

Check if Credit Card statement address is the same as Mailing Address

Check if Credit Card statement address is the same as Physical Address

Billing State:

Expire Month

Expire Year

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. Fleet Management Strategies, One Hour Authority and 1 Hour Process Agents are third party providers of consultive service to assist companies and individuals in acquiring and updating authority, permits and documents required by the Federal Motor Carrier Administration (FMCSA), U.S. Department of Transportation (USDOT), State and Local government agencies. (Terms and Conditions)

<h2>MCS150 (USDOT NUMBER) DEACTIVATION ORDER FORM</h2>
</div>
<div class="row">
<h4>Enter the name of the person or officer that is the responsible party: </h4>
<div class="col-md-4">
<input type="text" class="form-control" id="first_name" name="first_name" placeholder="First Name of Owner or Officer ">
</div>
<div class="col-md-4">
<input type="text" class="form-control" id="last_name" maxlength="80" name="last_name" placeholder="Last Name of Owner or officer ">
</div>
<div class="col-md-4">Title or Role
<select id="00N30000007akph" name="00N30000007akph" size="1">
<option value="">--Choose One --</option>
<option value="Owner">Owner</option>
<option value="President">President</option>
<option value="Vice-President">Vice-President</option>
<option value="Partner">Partner</option>
<option value="Corporate Sec">Corporate Sec</option>
<option value="Manager">Manager</option>
<option value="Manager">Member</option>
</select>
</div>
</div>
<div class="row">
<h4>Enter the name of your Company. If you are a "Sole Proprietor" enter your first and last name</h4>
<div class="col-md-6">
<input type="text" class="form-control" name="company" id="company" placeholder="Name of the Company (if sole propritor that is the name of the owner)">
</div>
<div class="col-md-6">
<input type="text" class="form-control" id="00N30000008boj3" maxlength="100" name="00N30000008boj3" placeholder="DBA, Doing Business Name">
</div>
<div class="col-md-6">
<input type="text" class="form-control" id="00N30000008bony" maxlength="10" name="00N30000008bony" placeholder="Enter your current USDOT Number">
</div>
<div class="col-md-6">
<input type="text" class="form-control" id="00N30000008boo8" maxlength="8" name="00N30000008boo8" placeholder="Enter your current USDOT PIN Number, if you currently have one">
</div>
</div>
<div class="row">
<div class="col-md-6">
<input type="text" class="form-control" id="00Na000000AqBPZ" maxlength="11" name="00Na000000AqBPZ" placeholder="EIN (Employer Identification Number), if you have one NO DASHES XXXXXXXXX">
</div>
<div class="col-md-6">
<input type="text" class="form-control" id="00Na000000AqBPU" maxlength="11" name="00Na000000AqBPU" placeholder="Social Security Number, Required if you do not have a EIN NO DASHES XXXXXXXXX">
</div>
</div>
<div class="row">
<div class="col-md-4">
<input type="text" class="form-control" name="phone" id="phone" placeholder="Telephone Number NO DASHES">
</div>
<div class="col-md-12">
<input type="checkbox" id="00N3p000003r3yb" name="00N3p000003r3yb" value="1">
<label for="checkbox">Check if Mobile Number is Same as Phone Number</label>
</div>
<div class="col-md-4">
<input type="text" class="form-control" name="mobile" id="mobile" placeholder="Mobile Number NO DASHES">
</div>

</div>
<div class="row">
<div class="col-md-6">
<input type="text" class="form-control" id="email" maxlength="80" name="email" placeholder="Email Address">
</div>
</div>
<div class="Row">
<div class="col-md-12">
<h4>Communication Notice</h4>
<h5>One Hour Authority may send your mobile phone a text to communicate the status of the order. One Hour Authority will only text you in regards to this order. You may "OPT IN" to receive texts from One Hour Authority by checking the box below.</h5>
<div class="form-group">
<input type="checkbox" id="00N3p000003r3rp" name="00N3p000003r3rp" value="1">
<label for="checkbox">Check to OPT IN to receive texts</label>
</div>
</div>
</div>
<div class="Row">
<div class="col-md-12">
<h4>Payment Information</h4>
<h5>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.</h5>
</div>
<div class="col-md-12">
<div class="form-group">
<label for="Authority Units and Pricing">Authority Units and Pricing</label>
<select name="00N30000008booD" id="00N30000008booD" title="Authority Units and Pricing">
<option value="$75 - USDOT NUMBER DEACTIVATION">$75 - USDOT NUMBER DEACTIVATION</option>
</select> AUTHORITY UNDISMISSAL