Membership Application

Application for Membership

The Machinery Haulers Association, Inc.
1232 Lake View Drive, Buckingham, IA 50612-9783
Phone: 319-214-7323

Applying for Membership as a:

Motor Carrier Member

Allied Member

Name of Applicant Company:*

If a Motor Carrier, US DOT Number:*

Mailing Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone:

Fax:

Toll-free Number (Optional):

Website:

Primary Type of Service Provided:

Number of OTR Power Units Operated (if a Motor Carrier):

If a Motor Carrier, what % of your business is from asset-based operations?

Primary Company Representative:*

Title:

His/Her Cell:

E-mail Address*:*

Secondary Company Representative:

Title:

His/Her Cell:

E-mail Address:

Company President’s Name:*

E-mail Address:*

Any Additional Information You Wish to Provide: