{{ Cognito.resources['order-number-label'] }}: {binding displayValue}

{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{binding BillingName}

{binding BillingAddress.FullInternationalAddress}

{binding PhoneNumber}

{binding EmailAddress}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{binding Name}:	{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:	({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

STATUS NOTIFICATIONS:

In an effort to provide status updates of your UCR filing, we require a working cell phone number and/or email address where you'll receive filing status notifications.

This will help to keep you updated as to the status of your application filing.

(You can unsubscribe at any time.)

I'd like to receive notifications about the status of my application via: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Enter Cell Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Enter Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

I agree to receive text receipts and application status to this number. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

COMPANY INFORMATION:

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DOT {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Is this your mailing address? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Provide your mailing address below if ordering mailed certificates: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

OPERATIONS:

Operation type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Do you operate any vehicles that are over 26,000 lbs in gross weight rating? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

UCR PAYMENT DATA:

How many vehicles in your fleet which cross state lines? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

2021 UCR Fee + Filing Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

2022 UCR Filing

IMPORTANT:
If you intend to operate as interstate carrier in 2022, and have not PAID (filed) the 2022 UCR, you may be out of compliance with the UCR Mandate as of January 1, 2022 even if you file 2021 UCR Registration.

(Please select one of the options from below)

I have already filed 2022 UCR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

I am not sure, please verify status and contact me {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

I need to file 2022 UCR {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

How many vehicles in your fleet which cross state lines in 2022? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

2022 UCR Fee + Filing Fee {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

UCR CERTIFICATION:

In 2021 UCR Registration Certifications and ID cards are offered to motor carriers.

UCR registration Certificates may be kept on file in your company as proof of filing the 2021 UCR. UCR ID cards are 2.5'' x 3.25'' laminated documents that can be carried inside your vehicles as proof of compliance with the 2021 UCR mandate which will be enforced by state troopers and other state agents commencing January 1, 2021.

Both UCR Certificate and UCR ID cards will have your UCR verification code printed on them.

Add UCR Certificate(s) ($45+) ? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

2021 ID Cards {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Add Certificate and ID Cards for year 2022 also? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Certified and issued by the Northwest Processing Center, division of Federal Applications Processor, Hoffenmer.

Refunds:
All application submissions are final and once processed refunds will not be issued. Refunds will be accepted if requested within 48 hours of filing AND only if an application has not yet been processed/submitted with the U.S. DOT/FMCSA. UCR payments that have been processed by the U.S. DOT will not be refunded by the Processor.

I hereby declare that the bank account or debit/credit card information furnished by me is true to my knowledge and I authorize Hoffenmer to furnish my account information to make payment for UCR registration. I also agree to the refund policy as described above. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Signature (please sign using your computer mouse or finger if using a handheld device) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Today's Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Processing: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Federal Compliance Add-Ons:

UCR Registration is one of many federal mandates that a motor carrier may need to comply with. Please select which other DOT/FMCSA mandates you would like to automatically request filing assistance with to be fully compliant for the 2020-2021 period.

When bundled with this UCR application these services will result in savings when filing through the Federal Applications Processor.

US DOT Biennial Update {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

US DOT Biennial Update is required every 2 years. Filing period is dependent on last two digits of the company's DOT Number.

Clearinghouse Registration (due Jan 5, 2021) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

All CDL holders must enroll in the Clearinghouse and conduct queries every 12 months thereafter.

Heavy Vehicle Use Tax (2290) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

2290 Filing is an IRS Heavy Vehicle Use Tax filing. All vehicles with GVWR at or above 55,000 pounds using public highways must pay this annual tax.

Safety Compliance Program {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Your CSA Safety Scores will be monitored and you will be alerted quarterly about significant changes and how/which drivers contribute to your compliance rating.

DOT Pin Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

THE U.S. DOT PIN NUMBER IS A UNIQUE PERSONAL IDENTIFICATION NUMBER RECEIVED FROM THE U.S. DOT.

The DOT PIN IS COMPOSED OF THE FOLLOWING FORMAT:
NUMBER-LETTER-NUMBER-NUMBER-LETTER-LETTER-NUMBER-LETTER (#@##@@#@)

Asst Agent {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

COMPANY INFORMATION:

OPERATIONS:

UCR PAYMENT DATA:

2022 UCR Filing

UCR CERTIFICATION:

Federal Compliance Add-Ons:

{~ Payment_Block_Label}

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-billing-info-header'] }}

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-billing-info-header'] }}

COMPANY INFORMATION:

OPERATIONS:

UCR PAYMENT DATA:

2022 UCR Filing

UCR CERTIFICATION:

Federal Compliance Add-Ons: