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9 Union St N, STE 400
Concord North Carolina 28025
704-773-9699
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Coverages
Resources
CLIENT SERVICE
Get a Certificate
MVR Request
ADDITIONAL RESOURCES
YouTube Channel
Schedule a Call
Start Up Checklist
Owner Op Lease Agreement
Accident Release Form
Amazon Relay Intermodal and UIIA Loads
FAQs
TRUCKING LIBRARY
Recent
IRS VCSP – Voluntary Classification Settlement Program
March 13, 2024
How to Get Cheaper Truck Insurance Quotes
November 28, 2023
All Articles
Partners
Contact
About
Our Agency
About Us
Daniel Summers
YouTube Channel
Schedule a Call
Write a Google Review
Get in Touch
9 Union St N, STE 400
Concord North Carolina 28025
704-773-9699
Client Support
Get a Quote Now
UIIA Participating Party Agreement
UIIA Participating Party Agreement
Charles String
2022-05-19T14:03:21-04:00
Company Name
(Required)
***Must match FMCSA exactly***
Owner's Name
(Required)
First
Last
Title
(Required)
CEO, President, Owner, Member, etc.
Company Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
(Required)
Email
(Required)
SCAC Code
(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.
MC Number
(Required)
DOT Number
(Required)
Tax ID / EIN
Signature
(Required)
Today's Date
(Required)
MM slash DD slash YYYY
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