Hazmat Permit Application Form

Note: This application does not include state-specific compliance fees beyond the annual permit cost. A $600 service fee applies for each annual permit requested. This fee covers one year of Hazmat permit registration and processing.

Legal Business Name: *

Doing Business As:

DOT Number: *

FEIN / Tax ID:

Primary Contact Name: *

Contact Phone Number *

Contact Email Address *

Business Address *

Permit Request Details

Type of Permit Request:

Hazmat Annual Permit
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Number of Hazmat Permits Requested:

1
2
3
More than 3 – Please Contact Us
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State of Travel: *

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Hazardous Material Classes Transported:

Average Quantity Transported (per shipment):

Primary Routes of Travel:

Vehicle Information

For Each Vehicle, Please complete the section below:

Vehicle #1 Details Below

Vehicle 1: Year / Make / Model / Color: *

Vehicle 1: VIN (Vehicle Identification Number): *

Vehicle 1: License Plate Number & State: *

Vehicle 1: Current Mileage: *

Vehicle 1: State of Registration: *

Vehicle 1: Unit Number

Gross Vehicle 1 Weight Rating (GVWR):

Vehicle 1 Type (e.g., Truck, Tractor, Bus): *

Has vehicle 1 operated in California? (Yes/No): *

Yes
No
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Vehicle #2 Details (if applicable)

Vehicle 2: Year / Make / Model / Color:

Vehicle 2: VIN (Vehicle Identification Number):

Vehicle 2: License Plate Number & State:

Vehicle 2: Current Mileage:

Vehicle 2: State of Registration:

Vehicle 2: Unit Number

 Gross Taxable Weight Vehicle 2 (GVWR):

Vehicle 2 Type (e.g., Truck, Tractor, Bus):

Has vehicle 2 operated in California? (Yes/No):

Yes
No
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Vehicle #3 Details (if applicable)

Vehicle 3: Year / Make / Model / Color:

Vehicle 3: VIN (Vehicle Identification Number):

Vehicle 3: License Plate Number & State:

Vehicle 3: Current Mileage:

Vehicle 3: State of Registration:

Vehicle 3: Unit Number

 Gross Taxable Weight Vehicle 3 (GVWR):

Vehicle 3 Type (e.g., Truck, Tractor, Bus):

Has vehicle 3 operated in California? (Yes/No):

Yes
No
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Schedule a Consultation for more than 3 permits?

Yes
No
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Supporting Documents

Please upload clear copies of the following:

Proof of Insurance with Hazmat coverage

Vehicle Registration(s)

DOT Hazardous Materials Safety Permit (if already obtained)

Any State-Specific Hazmat Transport Authorization

Other Supporting Documents

Please submit your payment of $600 to begin your Hazmat Permit Application and enter your payment details below to complete your request. *

$ 600

*100% secure & safe payments*

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