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WISCONSIN MOTOR CARRIERS ASSOCIATION

MEMBERSHIP APPLICATION

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

 
Company Name
Contact Name
Title
Mailing Address
Street Address
City
State
Zip
Phone
Fax
Watts
Email

Website:
 

Annual Dues Schedule: 

Allied Division $495
Trucking company with 1-20 power units $335
Trucking company with 20 or more power units $17/power unit
(Ex. 25 units x $19 = $475)
 
No. of Power Units:

Please check all that apply:

Truckload Carrier Livestock Hauler
Less Than Truckload Heavy & Specialized
Refrigerated Private
Van Carrier Tank Carrier
Hazardous Materials Flatbed
Dump Truck
Warehouse 		Allied (Please specify type of business)

Payment options: Check enclosed Bill me Charge to my credit card (MC/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 this form out and either mail or fax it to:

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

 

Copyright 1999
This page last updated: November 1, 2007