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Own Authority Application
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OWN AUTHORITY APPLICATION
DOT #
*
Company Name (if any)
FEIN (if any)
First Name
*
Last Name
*
Street Address
*
City
*
State
*
Zip Code
*
Email
*
Phone #
*
Date of Birth
*
Month
Years as Owner/Operator (if any)
*
Last 4 of Soc #
*
Owner is Driver?
*
YES
NO
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