Application-Form-ONT-Based-For-Hire-Carrier

For-Hire Carrier OTA Membership Application Form
General Information About Your Company

(Getting Started)
Company Name*
Operating As
Mailing Address*
City*
Province
Postal*
Main Phone*
Enter company main phone number
Main Fax
Please enter a valid phone number.
Toll Free
Enter toll-free (if any)
Billing Address (if different from mailing)
Company Email (for OTA Carrier Weblink)
example@example.com
Website URL
CVOR #*
# Employees*
Do you wish to have your company information listed on OTA's on-line carrier directory?*

YesNo

Key people to receive OTA's on-line newsletter, or to contact regarding specific issues
Official OTA Voting Representative (Preferably the CEO)*
Enter Full Name
Direct Phone
Extension
Title
Mobile Phone
Email Address
example@example.com
Signature

Clear

Senior Management - Area of Responsibility

	Name	Phone	Extension	Email Address
President/CEO/Owner
Operations
Safety
Maintenance
Finance
Purchasing
Human Resources
Sales & Marketing
Customs

How the OTA Dues are Calculated
Cost per Truck
Minimum Dues
Maximum Dues
(Fees are pro-rated based on OTA's fiscal year which commences on January 1^st)

To determine your pro-rated fees payable with this application multiply 1/12^th of your annual fee by the number of full or partial months remaining in OTA's fiscal year at the date of this application.
A. Select the month you are applying for membership
B. Total # of Trucks (include ALL subsidiary/affiliate companies & division)*
Enter the combined total power units from ALL CVORs
C. Annual Membership Dues
D. Your Pro Rated Membership Dues
E. HST (13%)
F. Total Membership Dues including HST
Method of Payment*

VISAAMEXMasterCard
To comply with the PCI DSS rules, OTA cannot ask for your credit card information. A member of our staff will give you a call to process payment by credit card.

Please provide the contact information below.
Contact Name
Contact Phone
Extension
Authorization

Clear
Privacy (Please Check if You Will Allow)*

Company name, mailing address, telephone, fax, website to be provided on request by OTA Allied Trades membersContact information for third parties who may be engaged by OTA from time to time to conduct industry surveys

Affiliate/Subsidiary Companies & Divisions (Under the OTA by-laws, carriers must declare all subsidiary and/or affiliated companies or divisions operating as independent comapnies or under different corporate names for fleet size and membership dues purposes)
Affiliate 1
Company Name
Mailing Address
City
Province/State
Postal/ZIP
Main Phone
Please enter phone number
Main Fax
Please enter fax number.
Toll Free
Please enter toll-free number.
Company Email (for OTA Carrier Weblink)
example@example.com
Website URL
CVOR #
# Trucks
Contact Name
Direct Phone
Extension
Title
Email Address
example@example.com
Affiliate 2
Company Name
Mailing Address
City
Province/State
Postal/ZIP
Main Phone
Please enter phone number
Main Fax
Please enter fax number
Toll Free
Please enter toll-free number
Company Email (for OTA Carrier Weblink)
example@example.com
Website URL
CVOR #
# Trucks
Contact Name
Direct Phone
Extension
Title
Email Address
example@example.com
Affiliate 3
Company Name
Mailing Address
City
Province/State
Postal/ZIP
Main Phone
Please enter phone number
Fax Number
Please enter fax number
Toll Free
Please enter toll-free number
Company Email (for OTA Carrier Weblink)
example@example.com
Website URL
CVOR #
# Trucks
Contact Name
Direct Phone
Extension
Title
Email Address
example@example.com
Affiliate 4
Company Name
Mailing Address
City
Province/State
Postal/ZIP
Main Phone
Please enter phone number
Fax Number
Please enter fax number
Toll Free
Please enter toll free number
Company Email (for OTA Carrier Weblink)
example@example.com
Website URL
CVOR #
# Trucks
Contact Name
Direct Phone
Extension
Title
Email Address
example@example.com
Should be Empty:

	City	Prov/State	Phone Number	Email Address
Location 1
Location 2
Location 3
Location 4

For-Hire Carrier OTA Membership Application Form

General Information About Your Company

Geographic Coverage

Power Units

How the OTA Dues are Calculated

Affiliate 1

Affiliate 2

Affiliate 3

Affiliate 4