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      Kansas Motor Carriers Services
      Carrier Membership Application
      * Your name:      
      * Phone:      
      * Fax:      
      * E-mail:      
      Job Title:
      * Company:      
      * Street Address:      
      (no PO boxes)        
      * City:      
      * State:      
      * Zip Code:      
      * Carrier Type
      * Number of Units Operated      
      * Required fields        
      1st Unit Based Dues  
      Additional 49 Units Dues    
      Over 50 Units Dues  
      Total Dues  
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