Pay Your Dues: Step 1

Thank you for starting your registration.

Please complete your registration by filling out the form below then proceeding to Paypal!

Membership Type

Company's Legal Name

DBA

Owner/Contact Name

Street

City

State

Zip

Phone

Toll Free

Fax

Email

Web Address

Number of Years in Business

Membership in NLA?

Check the appropriate box to indicate all vehicle types in your fleet
SedanSUVStretchStretch-SUVVanBusHybridSpecialtyWheelchair Accessible

Total Number of Pieces of Equipment in Your Fleet

Two Primary Cities You Service

Insurance Provider

PSC #

DOT #

MC #

Product(s) of Service(s) Offered

If you are operating one or more commercial motor vehicles in interstate and/or intrastate commerce are you currently in compliance with all federal and state requirements prescribing mandatory minimum levels of public liability insurance coverage?

Are you currently in compliance with all federal and state motor carrier operating licenses certificate or permit requirements?

I understand that my application to be an MLA Operator Member is PENDING until verification of my authority’s licensing and insurance requirements

Operators (Based on Fleet Size)

Please Invoice me via PayPal so that I can pay with a Credit Card:

Select One

OATH: I affirm That all the information contained within is true and correct to the best of my knowledge

Please Confirm This Oath By Clicking Below