Member Application

Welcome to Oregon Trucking Associations! We are glad you are interested in becoming a member. Please fill out the application below. Membership dues are based on all entities/companies with the same ownership. Contact info@ortrucking.org if you have any questions about membership.

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Facebook

Twitter

YouTube

Instagram

GooglePlus

Step 2:

Additional Info

Business Description (200 char max)

Business Keywords (enter a space between words)

Directory Category *

Please select a directory category.

Full-time Employees

Part-time Employees

# Trucks in Oregon

Total Trucks

# Oregon Employees

Previous Year's Oregon Miles

I understand that mileage required to be reported by motor carriers to the Oregon Department of Transportation (ODOT) in connection with the imposition or collection of any tax is exempt from disclosure by ODOT under ORS 825.517. Notwithstanding ORS 825.517, I hereby authorize ODOT disclose the annual mileage applicant reported to ODOT in connection with the imposition or collection of any tax to the OTA.

USDOT #

Safety/Risk Manager Name, Email, Phone

HR/Recruiting Manager Name, Email, Phone

Vehicle Maintenance Manager Name, Email, Phone

Operations/Dispatch Name, Email, Phone

Sales Manager Name, Email, Phone

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Cell Phone

Fax

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Create Account

Password

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Cell Phone

Fax

Email *

Please add a valid email.

Contact Preference

Phone

Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Create Account

Password

Back Next Submit Application Print Application

Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Social Network Addresses

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Create Account

Step 4:

Billing Contact

Address

Create Account

Step 5:

Membership Package

Additional Options:

Payment Option

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