Technical Support Service sign-up form

PLEASE PRINT OUT THIS MEMBERSHIP SIGN-UP FORM
This is not a secure document. For your protection, print out the form and send it to us by:

MAIL: Tran Services, PO Box 898, Milford, DE 19963
FAX: 1-800-367-0019 24 hours a day, 7 days a week
CALL with the info: 1-800-367-9100 Mon - Fri, 8:00 a.m. - 5:00 p.m. eastern time

Federal Register reprints, monthly issues of The Wheel News, and unlimited telephone support

Please complete the information below:

Number of drivers: ________ Type of commodity transported: _______________________________________

Number of vehicles: over 10,000 pounds gvwr ___________ over 26,000 pounds gvwr ___________

Do you transport: solely intrastate ___________ solely interstate ___________ both ___________

Do you transport any hazardous materials? Yes ___________ No ___________

Do you transport passengers for compensation? Yes ___________ No ___________

Do you require your drivers to complete a daily log book? Yes ___________ No ___________

Have you been audited by the U.S. D.O.T.? Yes ___________ No ___________

If yes, what is your safety rating? Satisfactory ___________ Unsatisfactory ___________
Conditional ___________ Unknown ___________

Company Name _____________________________________________________________________________

Contact Person ______________________________________________________________________________

Mailing Address______________________________________________________________________________

City _____________________________________________________________ State _____ Zip ____________

Area Code & Phone No. _______________________________________________________________________

Area Code & Fax No. _________________________________________________________________________

TERMS: (Make checks payable to Tran Services) #_______________

Account No. (All digits) __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date __ __/__ __/__ __

_____________________________________________________________________________
Signature required if using credit card

_____________________________________________________________________________
Please print name

1-800-367-9100 1-800-367-0019 Fax