What is you Federal Employer ID Number (If you do not currently have a FEIN leave blank and check the box below):
Yes, I would like to sign up for Fuel Tax Reporting Service. I will indicate the number of vehicles below. Includes required quarterly filing of IFTA, KY,NM,NY taxes and monthly filing of OR taxes. $35 Fee per vehicle per month. Fuel tax reporting requires that you submit completed monthly trip sheets (provided by us) and fuel receipts. We will automatically prepare the required filings. Call our Tax Compliance Unit TOLL FREE with any questions: (800) 450-7516.:
1 truck
2 trucks
3 trucks
4 trucks
5 trucks
6 trucks
7 trucks
8 trucks
9 trucks
10 trucks
Over 10 trucks, please call 800 450-7516
Choose Number of Trucks (quarterly filing service only)
List the states you will operate in (if all 48 states, write: "all 48":
What will you be hauling?:
Will you be hauling any hazardous materials? Please specify whether it will be hauled in cargo tanks or packages. Please specify the division and/or class of hazardous material.:
List the vehicle identification number (VIN), license plate or pass number, make of vehicle, number of axles, unloaded weight and gross weight for each vehicle:
If you already have an IFTA Number, please write the number and the name of your bases state:
If you already have a KYU Number, please write the number.:
If you already have a NM Weight Distance Tax Number, please write the number.:
If you already have a New York Highway Use Tax Number, please write the number.:
If you already have a OR Weight Receipt & Tax Identifier Number, please write the number.:
In the prior calendar year, did you file a New York State Highway Use Tax Return (MT-903)? If so, what was the total higway use tax and fuel tax liability?:
What is your USDOT Number (if you do not have one call 888 414 1874):
MC Number (if for-hire):
Are you a private carrier or for-hire carrier?:
What is your IRP Base State?:
What is you IRP Account Number?:
What is your business structure?:
Individual Proprietor
Partnership
Corporation
LLC
LP
PC
Ltd
Other
If a corporation, what state are you incorporated in?:
If a corporation, what is the date of incorporation?:
Who is/are the principal(s). Please advise title (i.e. "John Smith, President"):
How did you hear about us?:
Please enter the three digit security code on the signature panel all the way to the right on the back of your credit card. For Amex, this is a four digit code on the upper right hand corner of the front of your card. :