Application-Form-OOP-For-Hire-Carrier

Out-of-Province For-Hire Carrier

OTA Membership Application Form
General Information About Your Company
Company Name*
Operating As
Mailing Address*
City*
Province*
Postal/Zip Code*
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
Commercial Registry Permit/Number
NIC/CVR
# Employees*
Do you wish to have your company information listed on OTA's on-line carrier directory?*

YesNo
Trucking Services Your Company provides (check ALL that apply)*

Bulk DryBulk LiquidContainerContractFreight BrokerageHeavy SpecializedIntermodalLess-Than-TruckloadLivestock3rd Party LogisticsTruckload (General)WarehousingWaste
Geographic Coverage

Areas in Canada and the US that your company services.
Canada*

OntarioAtlantic CanadaQuebecWestern Canada
United States

Great LakesMidwestSoutheastNorthwestNortheastCentralSouth-CentralSouthwest
Commodities Hauled*

Agriculture ProductsAutomotive PartsBoatsBuilding/Const MaterialsCement/Stone/AggregateChemicalsExplosivesFertilizerFood Grade ProductsGroceries/ProduceHeavy EquipmentLivestockLumber ProductsMachineryMail/ParcelsNew/Used VehiclesPaper & Paper ProductsPetroleum ProductsRadioactive MaterialsRaw Forest ProductsRetail/Consumer ProductsScrap Steel & MetalsSteel & MetalsTextilesWaste/Recyclables
Program Designation/Participation (Security:Canada-US | Environment)

CSAC-TPATFASTPIPTWICSmartway
Trailers (check ALL That Apply)*

Car CarrierContainer ChassisDumpFlat-DeckFloatLCVLivestockReeferTankVan
Power Units
Total # of Tractors (Company Owned/Leased)
Total # of Tractors (Owner-Operator)
Total # of Straight Trucks (Company Owned/Leased)
Total # of Straight Trucks (Owner-Operator)

Terminal Locations

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

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.
PLEASE USE THE "TAB" KEY ON YOUR KEYBOARD TO SHOW THE PRO-RATED CALCULATION OF YOUR DUES PROPERLY.
C. Annual Membership Dues
D. Your Pro Rated Membership Dues
E. HST/GST
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

Out-of-Province For-Hire Carrier

General Information About Your Company

Geographic Coverage

Power Units

Key People (to receive OTA's on-line newsletter, or to contact regarding specific issues)

How the OTA Dues are Calculated

Affiliate 1

Affiliate 2

Affiliate 3

Affiliate 4