Form MCSA-5889 Motor Carrier Records Change Form

FORM MCSA-5889

OMB No.: 2126-0000

Revised 09/02/2014

Expiration: 00/00/2000

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with
a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB
Control Number. The OMB Control Number for this information collection is 2126-0000. Public reporting for this collection of information is estimated
to be approximately 15 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the
collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety
Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D.C. 20590.

United States Department of Transportation
Federal Motor Carrier Safety Administration

FMCSA — Office of Registration & Safety Information
6th Floor, 1200 New Jersey Ave. SE, Washington, DC
Fax: (202) 366-3477 (Licensing)
(202) 385-2422 (Insurance)
Customer Service: (800) 832-5660

FMCSA Office of Registration and Safety Information
Motor Carrier Records Change Form

FORM MCSA-5889

Name and address changes and reinstatements of operating authority can be requested on our web site at https://li-public.fmcsa.dot.gov/LIVIEW/
PKG_REGISTRATION.prc_option (supporting documents must be submitted separately). If you do not have access to the Internet you may submit this form to the
above address or fax to 202-366-3477. There is no fee for an address change, but name changes cost $14 and reinstatements $80. For more assistance with these
transactions and other Registration, Licensing and Insurance functions (including transfers of operating authority), see the FAQs at http://www.fmcsa.dot.gov/faq.
Please submit all the requested data in Section A as represented in your current DOT records. Changes can be indicated in Section B for address changes, Section C for
name changes, and Section D for Reinstatements. Credit card information can be submitted in Section E. Any partially-submitted data will be kept for 30 days. If the rest
of the information is not submitted within that time, the submitted data will be discarded. FMCSA cannot make any changes until all required data is supplied.

Section

A

ALL MUST COMPLETE

TODAY’S DATE
REQUESTOR’S FAX NUMBER (include area code)

REQUESTOR’S E-MAIL ADDRESS (if any)

MOTOR CARRIER IDENTIFICATION INFORMATION:
CURRENT LEGAL NAME (personal, partnership, or corporation)
DOCKET/MC NUMBER

CURRENT “DOING BUSINESS AS NAME” (if different from legal name)

MX NUMBER: (MX only)

DOT NUMBER

RFC NUMBER: (MX only)

FF NUMBER: (freight forwarders only)

ADDRESSES (as currently listed in FMCSA systems):
STREET ADDRESS

YT
WY
WV
WI
WA
VT
VI
VA
UT
TX
TN
SK
SD
SC
RI
QC
PW
PR
PE
PA
OR
ON
OK
OH
NY
NV
NU
NT
NS
NM
NL
NJ
NH
NE
ND
NC
NB
MT
MS
MP
MO
MN
MI
MH
ME
MD
MB
MA
LA
KY
KS
IN
IL
ID
IA
HI
GU
GA
FM
FL
DE
DC
CT
CO
CA
BC
AZ
AS
AR
AL
AK
AB
STATE/PROV.

CITY

PHONE NUMBERS:
CURRENT CELL PHONE
NUMBER (include area code)

B

Applicant

Representative

NAME (print or type)
TITLE

Section

TELEPHONE NUMBER
(include area code)

APPLICANT/REPRESENTATIVE SIGNATURE:
Form was completed by:

CURRENT BUSINESS NUMBER
(include area code)

ZIP CODE

SIGNATURE

ADDRESS CHANGES ONLY

Submit Address Change Requests to FMCSALicensing@
dot.gov or fax to (202) 366-3477.

MX Carriers only:

NEW STREET ADDRESS

NEW STATE/COUNTRY

I am enclosing a copy of my
Tarjeta de Circulacion (required).

NEW CITY

FORM MCSA-5889 • Page 1 of 2

TELEPHONE NUMBER
(include area code)

ZIP CODE

FORM MCSA-5889

Section

C

OMB No.: 2126-0000

Revised 09/02/2014

Expiration: 00/00/2000

NAME CHANGES ONLY

Is there any change in ownership, management, or control of the company? Are you a Mexican carrier?
Submit Name Change Requests to FMCSALicensing@dot.gov or fax to (202) 366-3477.
Yes — if you answer yes to one of the questions, you must report a
transfer of authority or select one of the options in the next box:

No — there is no change in ownership; skip the next box and enter
new name below it:

I am making one of the following changes which does not require a transfer (select one) but does require documentation (include with form submission):
Addition or deletion of close blood relatives, i.e., child, spouse, or
sibling (notarized letter enclosed)
Addition of partner through marriage (marriage license enclosed)
Changes to existing corporation (copy of articles of incorporation from
the state government enclosed)
Deletion of partner through death (copy of death certificate enclosed)

Deletion of spouse due to divorce (copy of divorce agreement enclosed)
Incorporating (copy of articles of incorporation from the state
government enclosed)
I am an MX carrier and am also enclosing a copy of my Tarjeta de
Circulacion

I authorize the Federal Motor Carrier
Safety Administration to charge $14 to the
credit card below for this name change.

NEW “DOING BUSINESS AS NAME”
(if different from legal name)

NEW LEGAL NAME
(personal, partnership, or corporation)

I have attached payment in the amount
of $14 in the form of a check of money
order, payable to FMCSA, to the address
in Section E.

Section

D

REINSTATEMENT OF OPERATING AUTHORITY ONLY

Submit Reinstatements to FMCSAReinstatements@dot.gov or fax (202) to 385-2422.
I would like to reinstate the following authority(s):
Motor carrier operating authority
Broker authority

Freight Forwarder authority

Please check the box to indicate your assent to this statement:
I understand that reinstatements may not be processed immediately. It is the responsibility of the motor carrier to ensure that they are in full
compliance with all FMCSA regulations prior to beginning interstate operations. More instructions can be found at www.fmcsa.dot.gov/FAQ.
AND check one of the following options:
I authorize the Federal Motor Carrier Safety Administration to reinstate the operating authority of the Motor Carrier/Broker/Freight Forwarder
identified above. I understand that the credit card below will be charged $80, and that this Authorization will be stored electronically with the credit
card number obscured, except for the last four numbers.
I authorize the Federal Motor Carrier Safety Administration to reinstate the operating authority of the Motor Carrier/Broker/Freight Forwarder
identified above. I have attached payment of $80 in the form of a check or money order, payable to FMCSA, to the address in section E.

Section

E

PAYMENT: NAME CHANGES
AND REINSTATEMENTS ONLY
Pursuant to 49 CFR 360.3(c), fees are not refundable. After the application or document has been accepted for filing by the FMCSA, the
filing fee will not be refunded, regardless of whether the document is granted or approved, denied, rejected, dismissed or withdrawn.
CREDIT CARD NUMBER

VISA
American Express

MasterCard
Discover

NAME ON CARD

BILLING ADDRESS

American
Alberta
Alaska
Alabama
British
Arkansas
Arizona
District
Delaware
Connecticut
Colorado
California
Marshall
Manitoba
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
Newfoundland
North
Northern
Northwest
Nova
Prince
Pennsylvania
Palau
Oregon
Ontario
Oklahoma
Ohio
Nunavut
Puerto
Rhode
Quebec
Saskatchewan
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Yukon
Wyoming
Wisconsin
Brunswick
Hampshire
Jersey
Mexico
York
Virginia
Scotia
Carolina
Dakota
Carolina
Dakota
Edward
Island
Islands
Columbia
Rico
ofIslands
Marianas
Samoa
Columbia
Territories
Island
and Labrador
STATE/PROVINCE

ZIP CODE

-

PAYMENT:

CITY
SIGNATURE

I am paying with a check or money order, which I will send with this form to:
Regular mail:
Federal Motor Carrier Safety Administration
P.O. Box 530226
Atlanta, GA 30353-0226

EXPIRATION DATE

Overnight express mail:
Bank of America
Lockbox Number 530226
1075 Loop Road
Atlanta, GA 30337

FORM MCSA-5889 • Page 2 of 2

DATE

$14 (Name Change)
$80 (Reinstatement)