NYSMTA - Sign-Up Form

Please fill out the form below and a NYSMTA representative will be in touch within one (1) business day.
Company Name:
Contact First Name:
Contact Last Name:
E-mail:
Phone:
Fax Number:
Web Address:
Contact Preference:
Address:
City:
State:
Zip:
US DOT #:
NYS DOT #:
Principal Business Activity:
Company CEO:
Address of Company CEO:
Number of Employees:
Number of Tractors:
Numberof Trucks:
Annual NYS Revenue (Common Carriers Only)
	Current ATA Member?
	Would you like your weekly mailings sent by email?
	Would you like information about enrolling employee(s) in our Maintenance Council or Safety Council Programs?
Est. Monthly Membership Fee:	- Associate/Maintenance/Safety Council Member (in addition to main member dues) is $5 per month

828 Washington Avenue
Albany, New York 12203

Phone: (518)458-9696
Fax: 518-458-2525