Trip and Fuel Permits

First Name

Last Name

Work Phone *

Email *

Phone Other *

CARRIER INFORMATION

Legal Name

DBA

Mailing Address

Physical Address

City

State

Postal code

MC Number

DOT Number

EIN

VEHICLE INFORMATION

Unit #

Vehicle Year

Make

Type Of Vehicle

Tractor
Trailer
Truck
Self-Propelled
Bus
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Hauling Automotive Fuel

Yes

No

Serial Number/ VIN (ALL CAPS)

Registered GVW

License Plate # /State

Fuel Type

CNG
Diesel
Gas
Propane
None
Other
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Unladen Weight

Owned / Leased

Owned
Leased
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Owners Name (If Leased)

PERMIT INFORMATION - CHOOSE UP TO SIX

First Permit Type

AL 7-Day Fuel
AL 7-Day Trip
AL 7-Day Combo
AZ But at port of entry
AR Fuel- Buy fuel in & Keep receipts for validation
AR 72 -Hour Trip
CA 96 -Hour Trip
CA 96 Hour Fuel
CO buy at port of entry
CT 10 Day Fuel
CT 72 Hour Trip
DE 72 Hour Fuel
DE 72 Hour Trip
DC 6 Day Trip
FL 10- Day Fuel
FL 10- Day Trip
GA 10 Day Fuel
GA 72 Hour Trip
ID 120 Hour Fuel
ID 120 Hour Trailer
ID 120 Hour combo (also available at port of entry)
IL 96 Hour Fuel
IL 72 Hour Trip
IN 5 Day Fuel
IN 3 Day Fuel
IA 72 Hour Trip
IA 72 Hour Combo
KS One Trip Operation Authority
KY 10 Day Fuel
KY 10 day trip (Non-Reciprocal)
KY 10 day no KYU#
KY KYU# required for all vehicles greater than 55,000 lbs
LA Fuel- Buy fuel in & Keep receipts for validation
LA 48 Hour Trip
ME 72 Hour Fuel
ME 72 Hour Trip
MD 15 Day Fuel
MD 72 Hour Trip
MA 72 Hour Fuel
MA 72 Hour Trip
MA 72 Hour Combo
MI 5 Day Fuel
MI 72 Hour Trip
MN 5 Day Fuel
MN 5 Day Trip
MN 30 Day Trip
MS Fuel Buy Fuel in & Keep receipts for validation
MS 72 Hour Trip
MO 72 Hour Fuel
MO 72 Hour Trip
MO 72 Hour Combo
MT 72 Hour Trip
MT 72 Hour Fuel
NE 72 Hour Fuel
NE 72 Hour Tractor Trip
NE 72 Hour Trailer Trip
NE 72 Hour Combo
NV 24 Hour Trip
NV 24 Hour Fuel
NV 24 Hour Combo
NH 72 Hour Fuel
NH 72 Hour Trip
NH 72 Hour Combo
NJ IFTA 30 Day temp & Decal must provide NJ IFTA Acct#
NJ 72 Hour Trip
NJ 24 Hour Liquor
NM buy at port of entry
NY Hut/ AFC First Time Registration
NY Hut / AFC 30 Day & Certificate
NY Hut / AFC Duplicate Certificate
NY Hut/ WT Revision
NY Fuel 72 Hour
NY IFTA 30 Day Temp & Decal
NY IRP Trip 72 Hour
NJ 96 Hour Fuel
NC 3 Day Fuel
NC 10 Day Trip
ND 72 Hour Fuel
ND 72 Hour Trip
ND 72 Hour Combo
OH 1 Day Fuel
OH 2 Day Fuel
OH 3 Day Fuel
OH 4 Day Fuel
OH IFTA 30 Day Temp & Decal
OH 72 Hour Trip
OK 120 Hour Fuel
OR Fuel Port of Entry
OR 10 Day tractor trip
OR Psc Pass- Port of entry
PA 5 Day Fuel
PA 72 Hour Trip
RI 10 Day Fuel
RI 72 Hour Trip
SC 10 Day Fuel
SC 3 Day Fuel
SD 72 Hour Fuel
SD 72 Hour Tractor Trip
SD 72 Hour Combo
SD Permit not required for empty tractor or trailer
TN 7 Day Fuel
TN 72 Hour Trip
TX 20 Day Fuel
TX 72 Hour Tractor Trip
UT 96 Hour Fuel
UT 96 Hour Tractor Trip
UT 96 Hour Trailer Trip
VT 72 Hour Fuel
VT 72 Hour Trip
VA10 Day Fuel
VA10 Day Trip
WA 72 Hour Fuel
WA 72 Hour Tractor Trip
WV 10 Day Fuel
WV 10 Day Trip
WV 10 Day Combo
WI 72 Hour Fuel
WI 72 Hour Trip
WI. 72 Hour Combo
WY Port of Entry
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Date