Membership Application

Application for Membership

The Machinery Haulers Association, Inc.
P.O. Box 338, Dysart, Iowa 52224
Phone: 319-214-7323
tmha@machineryhaulers.org    www.machineryhaulers.org

Applying for Membership as a:

Name of Applicant:

Mailing Address:

Street Address:

City:

State:

Zip Code:

Phone:

Fax:

Toll-free Number (Optional):


Primary Type of Service Provided:

Number of OTR Power Units Operated (if a Motor Carrier):

If a Motor Carrier, what % of your business is from asset-based operations?


Primary Company Representative:

Title:

His/Her Cell:

E-mail Address:


Secondary Company Representative:

Title:

His/Her Cell:

E-mail Address:

Company President’s Name:

E-mail Address:

Any Additional Information You Wish to Provide: