Broker Authority Application Form

Note: Broker Authority services start at $300 for a standard filing. Additional services such as expedited processing, reinstatement, or multi-state filings may increase the total cost. Prices collected in this form will be applied toward your final invoice.

Legal Business Name:

Doing Business As:

Business Structure:

Sole Proprietorship
Partnership
LLC
Corporation
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EIN/Tax ID Number:

Business Phone Number:

Business Email Address:

Business Address

Contact Information

Primary Contact Full Name:

Title / Role:

Contact Phone Number: *

Contact Email Address: *

Operating Information

Type of Broker Authority Requested: *

Broker of Property
Broker of Household Goods
Both
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Do you currently have an active MC/MX Number? *

Yes
No
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Do you currently have an active USDOT Number? *

Yes
No
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MC/MX Number (if applicable):

USDOT Number

Do you need help with obtaining a BOC-3 Process Agent filing?

Yes
No
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Do you need help with obtaining a surety bond (BMC-84) or trust fund (BMC-85)?

Yes
No
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Insurance & Financial Responsibility

Surety Bond / Trust Type: *

BMC-84 (Surety Bond)
BMC-85 (Trust Fund)
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Bond / Trust Amount (Minimum $75,000):

Bonding / Insurance Company Name:

Policy Number (if available):

Effective Date:

Service Fee:

Broker Authority Application Filing - $300
Reinstatement of Broker Authority (if needed) - $250
Annual Permit Renewal (if applicable) - $100
Surety Bond Assistance (BMC-84/85) - $75
BOC-3 Filing (Process Agent) - $50

Pay the service fee now to get started — final pricing may adjust based on your authority type, vehicles, and drivers, and federal/state fees are billed separately. Please enter your payment details below to complete your request. *

$ 300

$ 250

$ 100

$ 75

$ 50

*100% secure & safe payments*

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