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Wisconsin Motor Carriers Association


A non-profit trade association concerned with problems and interests of truck transportation within the State of Wisconsin

Wisconsin Independent Contractors Division -- MEMBERSHIP APPLICATION

(Please fill in your information below and then print this form and mail or fax to the address or number below.)

Company Name: 
Contact Person: 
Title: 
Mailing Address: 
Street Address: 
City: 
State: 
Zip Code: 
Local Phone: 
Fax: 
WATTS: 
Email: 
Web site: 

Annual Dues Schedule: 
Independent Contractors:  $84

Payment options: Check enclosed   Bill me   Charge to my credit card (We accept MC or Visa)

If you are charging your dues on your credit card, please enter the information in the boxes below.

Credit card #: 
(Numbers only)		 Exp. date: 
(MM/YYYY)

Please print out this form and either mail or fax it to:

Wisconsin Independent Contractors Division
PO Box 44849
Madison, WI  53744-4849
Fax: (608) 833-2875

This page last updated: April 21, 2011

Wisconsin Motor Carriers Association
P.O. Box 44849   •   Madison, WI 53744-4849   •   Phone: (608) 833-8200   •   Fax: (608) 833-2875

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