E-File Unified Carrier Registration (UCR)

UCR - Unified Carrier Registration Application

Mailing Address

Street *

Please fill the Street Name.

City *

Please fill the City Name.

Zip Code *

Please fill the ZIP Code.

State *

Please select the State.

Name of Contact *

Please fill the Name of Contact.

Email address *

Please fill the Email Address.

Owner / Officer Name *

Please fill the Owner / Officer Name.

Title *

Please Select the Owner / Officer Title.

Phone Number *

Please fill the Phone Number.

Alternative Phone Number

Fax

Mailing Address

Street

City

Zip Code

State

Contact Information

Name of Contact

Owner / Officer Name

Title

Phone Number

Carrier Information

Type of Carrier

Registration Year to be Paid

Number of Vehicles

Base or Participating State

I hereby agree to give my consent to share my information with Simple UCR ( Authorised Service Provider) to process my Unified Carrier Registration on my behalf.

Please check the Terms & Conditions

Carrier Information

Payment Information

Fee Structure

Fleet Size Fee	Fee per Equipment	Processing Fee	Total UCR Fee

Payment Information

Card Number *

Please fill the card number .

Total Amount
$-

Expiration Month

Expiration Year

Security Code (CVV) *

Please fill the ccv.

Cardholder Name *

Please fill the cardholder name.

Have different billing address

First Name *

Please fill the First Name.

Last Name *

Please fill the Last Name.

Billing Address *

Please fill the Billing Address.

City *

Please fill the City.

State *

Please select the Billing state.

Zip Code *

Please fill the Zipcode.

Please select captcha.

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Contact Us

# 4380 Redwood Highway, San Rafael, CA 94903, USA.

#159, Darcy Pkwy, Lathrop, CA 95330, USA.

Support: 510 474 1376

Spanish Support: 224 215 5888

support@simpleucr.com

Support Timings:

Mon - Fri 7:00 am CST to 08:00 pm CST

UCR - Unified Carrier Registration Application

Mailing Address

Company Information

Mailing Address

Contact Information

Carrier Information

Payment Information

Fee Structure

Payment Information

Total Amount$-

Quick Links

Contact Us

Total Amount
$-