IFTA Registration Form – IFTA – International Fuel Tax Agreement

IFTA Application Form - In the State of

Carrier Info Confirm Your Official Representative
Vehicle Details Add Vehicles
Questionnaire Additional Info
Payment Info Pay and Complete Registration

Carrier Information

Step 1 - 3

Contact Person(Full Name)*

Email Address*

Business Phone*

Mobile* Same as Business Ph

Application Type*

License Year*

Business Type*

Base State*

Add an Active USDOT Number to Your IFTA Application*

USDOT Number I don't have an active USDOT number to attach!

USDOT Number of Another Carrier *

Your Own USDOT Number *

In order to register for the IFTA, you will need to have a valid USDOT number. We can help you get one! Click here or simply call to apply for your USDOT number.

Legal Name*

DBA Name

EIN*

Please Confirm Carrier Infomation*

Additional Carrier Info Required for the state of

IFTA Account Number*

NCDOR ID/State Number*

Last Payment*

IRP Account Number*

In order to register for the IFTA for the state of , Active IRP Registration is required . We can help you get one! Click here to apply for your IRP Account.

Secretary of State Entity Number

County Number*

Secretary of State Business ID*

KYTC Number*

When did/will your IFTA registration become active?

Describe the nature of the business requiring the use of a motor vehicle and list the commodities you transport.

Date of Incorporation *

State of Commercial Domicile*

Bank Name*

Bank Account Number*

Bank Phone*

Date of Incorporation in NC*

One Other Jurisdiction you'll operate in*

Bank Address*

Individual Carrier Opertaion Details

Individual Owner Full Name *

Owner SSN*

EIN

Date Of birth*

Start Date In Current Position*

Home Address*

Full Name*

Position*

SSN*

Date Of Birth*

Start Date In Current Position*

Home Address*

Owner's Full Name*

Position*

SSN*

Date Of birth*

Start Date In Current Position*

Home Address*

Physical Address

Mailing Address Same as Physical Address

Vehicle Details

Step 2 - 3

VIN*

Type of fuel used*

Decal Set (1 Set = 2 Decals) *

Vehicle Status*

Lease Agreement*

License Plate Number*

Vehicle Registration Number*

Base State*

If not tagged in MaryLand, select which state is it tagged in.

Has Apportioned plate in Wyoming

No.	VIN	Fuel Type	Action
ADD A VEHICLE
Total Cost: $

Questionnaire

Step 3 - 4

Have you ever been issued an IFTA from any Jurisdiction?

Yes

Jurisdiction*

Additional Details Required for the state of

Will you be operating vehicles in Connecticut that are required to pay the Highway Use Fee?

Yes

Is your business incorporated in Indiana?

Yes

Was your license cancelled in good standing?

Yes

Have you ever had a KY Intra For-Hire Certificate issued to you in another name?

Yes

Was the certificate cancelled?

Yes

Are your vehicles involved in a lease agreement?

Yes

Do you have a active IRP registration?

Yes

What is your base jurisdiction for IRP*

Do you have bulk storage?

Yes

Type of storage?*

Clear

Dyed

In which City?*

In Which State?*

Are you registered for the New York Highway Use Tax?

Yes

Do you have qualified motor vehicles that are registered as special mobile equipment for which you wish to set up a separate account?

Yes

If you have IRP Registered, what is the IRP base state for your vehicle(s)?

Yes

Base state*

Are any of your qualified motor vehicles licensed with the North Carolina Division of Motor Vehicles?

Yes

Do you have a currently active or previously active CCD Acc. number?

Yes

Do you have a currently active or previously active IRP Acc. number?

Yes

Do you have a currently active or previously active IFTA Acc. number?

Yes

Do you currently operate dual-fuel qualified vehicles?

Yes

Have you previously held an IFTA license in Washington State?

Yes

Have you ever been issued an IFTA license by another IFTA jurisdiction?

Yes

Were you ever affiliated with a company whose license has been revoked?

Yes

Payment Information

Step 4 - 4

Order Details

Vehicle Total	:
Total Cost	:	$

Billing Address

New Billing Address

Billing Address Same as Physical Address

Billing Address Same as Mailing Address

Address*

City*

State*

Zip Code*

I certify that I am the authorized holder and signer of the credit card referenced above. I certify that all the information above is complete and accurate.

I hereby authorize the collection of payment for all charges as indicated above. Charges may not exceed the amount listed above in the “TOTAL COST” field. I understand this is only for up to this amount on the date listed below in the "DATE SIGNED" field. If additional charges are going to be authorized, a new form will have to be completed.

The “TOTAL COST” includes all federal, state and local government fees.

I hereby acknowledge and agree that after the charges are authorized, a DOT Operating Authority agent is assigned in 15 minutes to run the order. Once the agent is assigned, the charges become non-refundable.

I agree with the Terms and Conditions

Name of Person Signing

Title

Official Representative

Date signed

03/25/2023

Signature

Canvas is not supported.

IFTA Application Form - In the State of

For the State of Montana You must upload atleat 3 Proofs of Residency