Fuel Tax Processing Application Form
Note: Service fee is $100 per quarter for the first truck/driver, plus $50 for each additional truck/driver. State filing fees, if applicable, are billed separately.
Service Request Details
Vehicle Information
For Each Vehicle, Please complete the section below:
Vehicle #1 Details Below
Vehicle #2 Details Below
Vehicle #3 Details Below
Load Details 3
Supporting Documents
Please upload clear copies of the following:
Service Fee:
1 Truck/Driver — $100 per quarter
2 Trucks/Drivers — $150 per quarter
3 Trucks/Drivers — $200 per quarter
Each additional truck/driver — $50 per quarter