UCR - Unified Carrier Registration Application

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Company Information

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Point of Contact

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Carrier Information

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Review

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Payment Information


Please fill the Company Name.
Please fill the Company DOT Number.
Please fill the Company FID# /EIN#.
Please select the Company FID# /EIN#.
Mailing Address
Please fill the Street Name.
Please fill the City Name.
Please fill the ZIP Code.
Please select the State.

Please fill the Name of Contact.
Please fill the Email Address.
Please fill the Owner / Officer Name.
Please Select the Owner / Officer Title.
Please fill the Phone Number.

Company Information
Please Select Registration Year.
Please Select the Number of Vehicles per Equipment.
Please Select the Base or Participating state.

Contact Information
Company Information

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Mailing Address

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Contact Information

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Carrier Information

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Please check the Terms & Conditions
Payment Information
Fee Structure
Fleet Size Fee Fee per Equipment Processing Fee Total UCR Fee
Payment Information
Please fill the card number .
Total Amount
$-
Please fill the ccv.
Please fill the cardholder name.
Please fill the First Name.
Please fill the Last Name.
Please fill the Billing Address.
Please fill the City.
Please select the Billing state.
Please fill the Zipcode.
Please select captcha.

Review Registration
Quick Links
Contact Us

# 4380 Redwood Highway, San Rafael, CA 94903, USA.

#159, Darcy Pkwy, Lathrop, CA 95330, USA.

Support: 510 474 1376

Spanish Support: 224 215 5888

support@simpleucr.com

Support Timings:

Mon - Fri 7:00 am CST to 08:00 pm CST