New Entrant

Safety Audit Compliance Application (DOT/FMCSA)

Service Fee: $800

$1,000 if submitted less than 2 days before your Safety Audit due date
(Rush service available upon request – contact us directly)

Legal Business Name: *

DOT Number: *

DOT PIN

MC Number (if applicable):

Address

Company Address *

City

State

Country

Postal code

Primary Contact Name: *

Phone *

Email *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (XXX) XXX-XXXX for assistance. You can reply STOP to unsubscribe at any time.

Safety Audit Due Date & Submission Timing

FMCSA Safety Audit Due Date: *

Are you submitting this form 2+ days before your due date? *

Yes, I am submitting 2 or more days in advance ($800)

No, I am submitting less than 2 days in advance ($1,000)

No, I need rush service (Contact us before proceeding)

Safety Audit Information

Number of Drivers Operating Under DOT Authority: *

Number of Commercial Vehicles (CMVs): *

Do you currently have an ELD provider? *

Yes

No

Name of Provider:

Have you kept up with driver qualification files, drug testing, and maintenance logs? *

Yes

No

Partially

Will this vehicle(s) be used across multiple states/jurisdictions? *

Yes

No

Desired Start Date of Registration: *

File Upload

Please upload the documents you've selected above.

A Copy of New Entrant Letter

Vehicle Maintenance Files

Driver Qualification Files

Insurance Certificate

Drug & Alcohol Testing Records

Hours of Service Logs

Accident Register

ELD Data

Payment Information

Service Fee:

$800 if submitted 2+ days before the due date
$1,000 if submitted less than 2 days before the due date
Rush service: Price & availability will be discussed after form review

Collect Payment *

$ 800

$ 1000

Agreement & Authorization

Please read below carefully:

By submitting this form, I authorize Llyod Brothers Logistics to begin work on my FMCSA Safety Audit preparation and submission. I understand the $1,000 fee is for standard service submitted less than 2 days prior to the due date, and rush service may incur additional charges.

Applicant Signature *

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Please Type Name *

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