New Form

Application Date *

Company *

Address *

City *

State *

Zip *

Company Telephone *

Company Website

Primary Contact Name *

Nickname

Title

Phone

Mobile Phone

Primary Contact Email *

Address (if different than above)

City

State

Zip

Company President/CEO

President/CEO Email

Are there additional subsidiaries or agents within your corporate structure?

Yes No

For further information, please call ATA at 1-888-333-1759.

What type of shipments do you haul?

Residential

Commercial/National Account

DOD/Military

GSA

Do you have Interstate Authority?

Yes No

If Yes, please provide the following:

DOT Number

MC#

FF#

State License Number

Number of Trucks

ATA Moving & Storage Conference members include small, medium and large companies that provide intrastate and interstate professional moving, storage and relocation services. ATA’s Conference membership dues are a $1,000 flat rate (includes 1 location) plus $250 per additional location.

Class 7 & 8 truck linehaul revenue
(year ending September 30, 2020) *

Number of Locations
*

Revenue ID *

Multiplier *

Negative Lower End of Range

Difference from Lower Range

Base Dues *

Additional Dues *

Annual_Dues_System *

Total Dues Amount

Sub_Total_Dues_Amount

Total Dues Amount finalized when Number of Locations is entered.

Please pay by check made payable to ATA.

Send to:

ATA Membership Department
950 North Glebe Road
Suite 210
Arlington, VA 22203-4181

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