Name	(required)
Title
Company	(required)
Address
City	(required)
State/Province
Zip/Postal Code
Phone
Fax permits to
E-mail

 

What name & address do you want listed on the permit? (only if different than the billing information)

Name
Company
Address
City
State/Province
Zip/Postal Code
Phone
US DOT #
For hire?
Insurance $ Amt

What is your load?

Description
Make
Serial #

 

Load dimensions & weight?

Overall Dimensions? (include axle information if GVW is over 80,000 lbs)

Legal is generally under 65' long, 8'6" wide, 13'6" high, or 80000lbs

 

 

Truck & Trailer Information? (Unit #s only are fine if we have this information in our computer system already)

 

What kind of permit(s) do you need?

Single Trip Oversize Permit        Single Trip Overweight Permit
Temporary Registration Permit (Trip)
Fuel Tax Permit
Multiple Trip/ Annual Permit (Please specify the length of time desired.)

 

State(s) Needed?

Alabama           Arizona               Arkansas          California
Colorado          Connecticut       Delaware          Florida
Georgia            Idaho                  Illinois                Indiana
Iowa                  Kansas               Kentucky          Louisiana
Maine                Maryland            Mass.               Michigan
Minnesota         Mississippi         Missouri           Montana
Nebraska          Nevada              New Hamp.      New Jersey
New Mexico      New York           N Carolina        N Dakota
Ohio                   Oklahoma           Oregon             Penn.   
Rhode Island     S Carolina          S Dakota          Tennessee
Texas                 Utah                    Vermont           Virginia
Washington       W Virginia          Wisconsin         Wyoming

 

Please list the route for each state separately  (ex: MN: from WI to SD on Int 90)

 

Effective Date? (Also include the starting time for Fuel Tax & Trip Permits)

                       

 

Additional Comments?

Please print a copy of your order before submitting to a permit agent.