***Must match FMCSA exactly***
Owner's Name(Required)
CEO, President, Owner, Member, etc.
Company Address(Required)
If you do not have a SCAC code yet, you can use your account number (located next to "Welcome" when you login to the UIIA portal, starts with "MC") until your SCAC code has been assigned. Once your application is complete, you will receive a notification advising that your company is now an active participant in the program.
Clear Signature
MM slash DD slash YYYY