Form Op-1 - Application For Motor Property Carrier And Broker Authority - U.s. Department Of Transportation Page 17

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Form OP-1

Payment Instructions

Each type of operating authority requested in Section II of the application form requires a $300 processing fee.

Calculate the total amount due as follows:

X $300 =

(Enter total number of boxes

(Enter total payment amount)

checked in Section II)

Select payment method:

Check or Money Order - Make payable to FMCSA in United States (U.S.) dollars.

Payment must be drawn upon funds deposited in a bank located in the U.S.

Credit Card - Complete the Credit Card Payment Authorization below.

Credit Card Payment Authorization

Select Credit Card

Total Payment Amount

Visa

MasterCard

Credit Card Number

Expiration Date

Name (exactly as it appears on credit card)

Credit Card Billing Address

Street Name and Number

City

State

Zip Code

Signature

Date

Mailing Instructions

(To apply online, please see “How to Apply” (Topic II) in this packet.)

Save a copy of the completed application form(s), all supporting documents (if any), and payment details for the company’s business records.

Depending upon the type of payment (and method of mail delivery), send the completed application form(s), any supporting documents, and payment to one of the following

addresses

(NOTE: Sending payment to the wrong address will delay application processing by 2-3 weeks

Check or Money Order

First-Class Mail

Federal Motor Carrier Safety Administration

P.O. Box 70935

Charlotte, NC 28272-0935

Express Mail

QLP Wholesale Lockbox – NC0810

Lockbox #70935

1525 West WT Harris Blvd.

Charlotte, NC 28262