UIIA Worker’s Comp and Employer Liability Exemption Letter

UIIA Worker’s Comp and Employer Liability Exemption LetterCharles String2022-05-19T15:42:54-04:00

Company Name(Required)

***Must match FMCSA exactly***

Owner's Name(Required)

First Last

Address(Required)

Must match business address on SAFER

City(Required)

State(Required)

Zip Code(Required)

Email(Required)

DOT Number(Required)

MC Number(Required)

Signature(Required)

Today's Date(Required)