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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Docket Number at the top of the form. This is essential for identifying your request.
- Fill in the name of the carrier, freight forwarder, or broker making the request. Ensure accuracy as this identifies who is requesting revocation.
- Provide the complete address of the requesting carrier, including street, city, state/province, and postal code. This information is crucial for processing your request.
- Select the authority type by checking all applicable boxes: Common, Contract, or Broker. This specifies what type of authority you are requesting to revoke.
- In the 'Reason for request of revocation' section, clearly state your reasons. This helps clarify your intent and supports your application.
- Complete the section for the authorized person's name and daytime telephone number. This ensures that FMCSA can contact you if needed.
- Sign and date the form where indicated. Remember that a notarized signature is required or it must be signed in front of an FMCSA staff member.
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