Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Owner's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Physical Address (if different than mailing) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
U.S. DOT Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
MC/MX Number (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Railroad Alphabetic Code (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Notes {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
The North American Industry Classification System (NAICS) Code for Primariy Business Activity is a 6-digit code. It is required to file the HazMat Registration Statement. If you do not know your code it can be verified for you with the NAICS for an additional charge.
NAICS code (Business Category - 6 digits) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
NAICS verification: Describe your type of business (cargo, operations): {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Activity (Offered or transported in commerce) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Processing and Application Fee Due Now {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
HazMat Registration Due Upon Processing by the U.S. DOT:
Small Business / Non Profit:
includes the $25 DOT processing fee
(1 year) = $275
(2 years) = $525
(3 years) = $775
Not Small Business:
includes the $25 DOT processing fee
(1 year) = $2,600
(2 years) = $5,175
(3 years) = $7,750
Am I 'Small Business' or 'Not Small Business' ?
The NAICS code (above) determines your business type. Your application will be filed if your NAICS code is Small Business. If it is determined that your business is Not Small Business, you WILL BE CONTACTED prior to filing you application. All filing fees over $1,000 will result in an agent contacting your company to confirm your application prior to processing this application with the U.S. DOT.
Pay by Credit Card
Name on Credit Card {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Credit Card Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Expiration Month {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Expiration Year {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
CVC code (back of credit card) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Billing Zip Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Pay by Bank Account
Name of Bank Account Owner {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Routing Number: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Account Number: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Verify Account Number: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Expedite Hazmat Certificate Processing - $47.50 {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
It is highly recommended to expedite the processing in order to obtain the HM Certificate by June 30th.
Add Mailed Laminated Certificate {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
From production mailed copy is received within 7-10 business days.
Asst Agent {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Important:
If you selected to Pay by Credit Card for Hazmat Certificate Endorsement, you must select check box below the credit card information below.