Carrier Membership Application

4181 W.2100S., West Valley, UT 84120

(801) 973 – 9370

jon@uthatrucking.com

Date

Company Name

DBA (If Applicable)

Key Contac Name

Title

Physical Address

Mailing Address

Phone

Safety / Supervisor Name

Accounts Payable Contact

Investment Due Levels

For Hire Carrier Private Carrier

Number of Tractor / Power Units

Authorized By

Title

Signature

Date

**Upon signing this application, this gives Utha Trucking Association the expressed permission to fax and/or email information to key contacts in your company, as per the Telephone Consumer Protection Act**

*Subject to review and approval by UTA Board of Directors.