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Name of Person Registering*

Company Name*

Physical Address*

Mailing Address (if different from physical address)

Phone*

Fax*

Email Address*

SS#

FEIN (You must have a Tax ID# to file a 2290)*

Have a DBA? *

Select an option

DBA?

Do you have Authority?*

Select an option

DOT#?*

MC#*

Gross Vehicle Weight w/cargo?*

How many axles?*

Message (Tell us exactly what you need)*

Satisfaction Guaranteed

For all of our services, we offer a satisfaction guarantee. We will work with you until you are completely satisfied because your satisfaction and keeping you on the road is our priority.

Briggamite IRP Services, LLC

info@briggamitetrucking.com

P: 912-659-7350 F: 912-358-1514

Serving the Georgia Ports Authority Area

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