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TRANSMIT AMERICA™
with TRANS/MID-AMERICA, inc.
14655 California Street
Omaha, NE 68154-1950

800-228-7577



Registation Information
COMPANY NAME:
COMPANY ADDRESS:
CITY:
STATE:
COMPANY PHONE: - - FAX: - -
COUNTY:
 ZIP: -
COMPANY EMAIL:
FEDERAL I.D. NO / SOCIAL SECURITY NO.:
MC / ICC NO.:
IFTA NO.:
US DOT:
KYU NO:
GA FUEL ACCOUNT NUMBER:
NAME:
TITLE:
For Oversize / Overweight Permits
ACCOUNT NUMBERS:
(if applicable)
LOUSIANA:
INDIANA:
TEXAS:
WISCONSIN:
INSURANCE COMPANY:
(Parent Company, not agent)
CITY:
AGENT PHONE NUMBER: - -
STATE:
POLICY NUMBER: AMOUNT OF LIABILITY:
EXPIRATION DATE:

2008
Our 40th Year		 Call us at:
800-228-7577
Contact Us