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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 Motor Carriers Association -- MEMBERSHIP APPLICATION

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

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

Annual Dues Schedule: 
Allied Division: $495
Trucking company with 1-20 power units: $335
Trucking company with 20 or more power units: $19/power unit (Ex. 25 units x $19 = $475)

Number 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 Allied (Please specify type of business below:)
 
Warehouse

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 out this form and either mail or fax it to:

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

This page last updated: March 30, 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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