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TRANSMIT AMERICA™
with TRANS/MID-AMERICA, inc.
14655 California Street
Omaha, NE 68154-1950

800-228-7577



Registation Information
  COMPANY NAME:
  COMPANY ADDRESS:
  CITY:
STATE:  
  COMPANY PHONE: - -    FAX: - -
  COUNTY:   
 ZIP:  -
  COMPANY EMAIL:  
              FEDERAL I.D. NO / SOCIAL SECURITY NO.:
              MC / ICC NO.:
              IFTA NO.:
              US DOT:
              KYU NO:
              GA FUEL ACCOUNT NUMBER:
                                                                      NAME: 
                                                                      TITLE: 
For Oversize / Overweight Permits
ACCOUNT NUMBERS:
(if applicable)
LOUSIANA:
INDIANA:     
TEXAS:      
WISCONSIN:
INSURANCE COMPANY:       
(Parent Company, not agent)
CITY:
AGENT PHONE NUMBER: - -
STATE:
POLICY NUMBER: AMOUNT OF LIABILITY:
EXPIRATION DATE:

2006
Our 38th Year		 Call us at:
800-228-7577
Contact Us