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Carrier Member Application
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Carrier Membership Application
Arizona Trucking Association has represented and provided services for the trucking and distribution industry since 1937. To help us provide superior service to your company, please be sure to completely fill in all the blanks. If a question doesn’t apply to your company, simply write “N/A”. Thank you!
COMPANY INFORMATION
My company is joining as a (select one):
(Required)
Please Choose One
For-hire Motor Carrier (hauls freight for other businesses)
Private Carrier (hauls own company’s products)
Type of business / Principal commodities hauled:
(Required)
Company Operates In:
(Required)
Please Choose One
Intrastate AZ Only
Interstate
Check if any apply to your company:
Household Goods Carrier
Petroleum / Hazmat Carrier
Specialized Carrier or Rigger
Company Name:
(Required)
DOT#:
(Required)
Mailing Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Website
(Required)
Main Phone
(Required)
Owner / CEO Name
(Required)
First
Last
Title
(Required)
Email
(Required)
Office Phone
Cell Phone*
(Required)
*By providing a cell phone number, you are opting in to receive text message updates from the Arizona Trucking Association (ATA). Phone numbers will never be shared, sold, or used for any purpose other than official ATA communications.
Carrier Dues Schedule:
(Required)
Please select annual Arizona miles driven
0 - 500,000 ($651.50)
500,001 - 1,000,000 ($847.00 Annual Dues)
1,000,001 - 2,000,000 ($1,237.75 Annual Dues)
2,000,001 - 3,000,000 ($1,628.75 Annual Dues)
3,000,001 - 4,000,000 ($2,019.50 Annual Dues)
4,000,001 - 5,000,000 ($2,410.50 Annual Dues)
5,000,001 - 6,000,000 ($3,127.00 Annual Dues)
6,000,001 - 7,000,000 ($4,039.25 Annual Dues)
7,000,001 - 8,000,000 ($4,690.75 Annual Dues)
8,000,001 - 9,000,000 $5,472.50 Annual Dues)
9,000,001 - 10,000,000 ($6,189.00 Annual Dues)
10,000,001 - 11,000,000 ($7,036.00 Annual Dues)
11,000,001 - 12,000,000 ($7,817.75 Annual Dues)
12,000,001 - 13,000,000 ($8,600.00 Annual Dues)
13,000,001 - 14,000,000 ($9,446.50 Annual Dues)
14,000,001 - 15,000,000 ($10,163.00 Annual Dues)
15,000,001 - 16,000,000 ($10,944.75 Annual Dues)
16,000,001 - 17,000,000 ($11,726.50 Annual Dues)
17,000,001 - 18,000,000 ($12,508.50 Annual Dues)
18,000,001 - 19,000,000 ($13,029.50 Annual Dues)
19,000,001 or more ($14,095.50 Annual Dues)
Annual AZ Miles:
(Required)
Applications must be submitted with most recent IFTA report summary
Max. file size: 32 MB.
Registered number of Arizona power units & straight trucks over 10,000 lbs. GVWR:
(Required)
Total Years in Business:
(Required)
Please enter a number from
0
to
500
.
Years Conducting Business in Arizona:
(Required)
Please enter a number from
0
to
500
.
Please provide a short blurb describing your company. This will be used in our new member announcement.
Please upload your company logo (jpg, png or pdf preferred)
Max. file size: 32 MB.
PUBLISHED CONTACT
This is the designated public point of contact. The name and phone number listed here will be included on contact lists shared with other Arizona Trucking Association (ATA) members upon request.
Is the published contact the same person as the Owner/CEO list above?
(Required)
Yes
No
Published Contact Name
First
Last
Published Contact Title
Published Contact Email
Published Contact Phone
Published Contact Cell Phone*
*By providing a cell phone number, you are opting in to receive text message updates from the Arizona Trucking Association (ATA). Phone numbers will never be shared, sold, or used for any purpose other than official ATA communications.
Is Published Contact address the same as Company Address listed above?
(Required)
Yes
No
Published Contact Address
Street Address
City
State / Province / Region
ZIP / Postal Code
BILLING CONTACT (If different from Owner/CEO)
Billing Contact Name
First
Last
Billing Contact Title
Billing Contact Phone
Billing Contact Email
Billing Contact Cell Phone*
*By providing a cell phone number, you are opting in to receive text message updates from the Arizona Trucking Association (ATA). Phone numbers will never be shared, sold, or used for any purpose other than official ATA communications.
HUMAN RESOURCES CONTACT (If different from Owner/CEO)
Human Resources Name
First
Last
Human Resources Contact Title
Human Resources Contact Phone
Human Resources Contact Email
Human Resoures Contact Cell Phone*
*By providing a cell phone number, you are opting in to receive text message updates from the Arizona Trucking Association (ATA). Phone numbers will never be shared, sold, or used for any purpose other than official ATA communications.
MARKETING CONTACT
Marketing Name (If different from Owner/CEO)
First
Last
Marketing Contact Title
Marketing Contact Phone
Marketing Contact Email
Marketing Contact Cell Phone*
*By providing a cell phone number, you are opting in to receive text message updates from the Arizona Trucking Association (ATA). Phone numbers will never be shared, sold, or used for any purpose other than official ATA communications.
PERSON RESPONSIBLE FOR VEHICLE LICENSING (If different from Owner/CEO)
Vehicle Licensing Contact Name
First
Last
Vehicle Licensing Contact Title
Vehicle Licensing Contact Phone
Vehicle Licensing Contact Email
Vehicle Licensing Contact Cell Phone*
*By providing a cell phone number, you are opting in to receive text message updates from the Arizona Trucking Association (ATA). Phone numbers will never be shared, sold, or used for any purpose other than official ATA communications.
SAFETY COMPLIANCE CONTACT (If different from Owner/CEO)
Safety Contact Name
First
Last
Safety Contact Title
Safety Contact Phone
Safety Contact Email
Safety Contact Cell Phone*
*By providing a cell phone number, you are opting in to receive text message updates from the Arizona Trucking Association (ATA). Phone numbers will never be shared, sold, or used for any purpose other than official ATA communications.
OTHER CONTACTS
ADDITIONAL EMPLOYEES FOR OUR DATABASE TO RECEIVE E-BULLETINS AND OTHER INDUSTRY INFORMATION.
Other Contact 1
First
Last
Other Contact 1 Email
Other Contact Cell Phone*
*By providing a cell phone number, you are opting in to receive text message updates from the Arizona Trucking Association (ATA). Phone numbers will never be shared, sold, or used for any purpose other than official ATA communications.
Other Contact 2
First
Last
Other Contact 2 Email
Other Contact2 Cell Phone*
*By providing a cell phone number, you are opting in to receive text message updates from the Arizona Trucking Association (ATA). Phone numbers will never be shared, sold, or used for any purpose other than official ATA communications.
If you prefer to provide an excel spreadsheet for your company contacts, please upload below
Max. file size: 32 MB.
ATA provides many opportunities to our members for marketing and networking.
Please check any you would like to learn more about.
ATA provides many opportunities to our allied members for marketing and networking. Please check any you would like to learn more about.
Buyer’s Guide – products/services
Drug & Alcohol Testing/Background Screening
Owner/Operator Insurance
PrePass Safety Alliance - Truck Bypass System
Vehicle Registration Services - Safety Supplies Carrier
ATA provides many opportunities to our allied members for marketing and networking. Please check any you would like to learn more about.
Event Sponsorship: Truck Driving Championships/Carrier Conference/Other Events
Safety & Maintenance Council
Seminars/ Training
Fleet Safety Awards Program
Legislative Updates
How did you hear about ATA?
From another member
Website
Attended an ATA seminar or Event
Total
Preferred Payment Method
(Required)
Check
Credit Card
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Security Code
Cardholder Name
CAPTCHA
Thank you for your application, dues payment and supporting documents. Once your application has been approved, you will receive a complete membership packet. For information in the meantime, contact us at 602-850-6000.
