Georgia Department of Public Safety
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Georgia Intrastate Motor Carrier Registration (GIMC) - Georgia Carrier Registration Only
If you are an Interstate Carrier (cross state line), please register UCR only at
www.ucr.gov
Business Officer First Name
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Business Officer Last Name
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Business Legal Name
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Doing Business Under The Following Name(DBA)
USDOT Number
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Digits only (0-9)
* Must be a valid USDOT# registered with FCMSA
Federal Employer Identification Number (EIN)
State Tax Id
Classification
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For Hire
Private
Motor Carrier Transporting Hazardous Materials
Bus/Motorcoach
Wrecker/Towing Company
Household Goods
Broker
Leasing Company
Freight Forwarder
Business Street
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Business City
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Business State
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Zip Code
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Check this box if Business Address and Mailing Address are the same.
Business Mailing Street
Business Mailing City
Business Mailing State
Zip Code
Telephone Number
Cell Phone Number
Fax Number
Email Address
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Consultant/Third Party
Consultant/Third Party Phone Number