Please select the service level required and complete all that applies to you and/or your company
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Service Start-up Information Sheet
COMPANY NAME
ADDRESS
CITY
STATE OR PROVINCE
ZIP/POSTAL CODE
PHONE
FAX
YOUR REPORTING AGENT EMAIL ID
YOUR EMAIL ID
COMPANY EMAIL ID
NO OF REPORTING TRUCKS/TRACTORS/UNITS
COMPANY NAME
CONTACT NAME
ADDRESS
CITY
STATE OR PROVINCE
ZIP/POSTAL CODE
PHONE
FAX
OTHER PHONE
YOUR EMAIL ID
NO OF REPORTING TRUCKS/TRACTORS/UNITS
YOUR IFTA REGISTERED BASE STATE/PROVINCE
Provide us with the Account Numbers for the Following where Applicable
NEW YORK HUT #:
KYU #:
KCC ID #:
KANSAS DOR #:
IFTA Tax ID #:
NEW MEXICO TAX ID #:
OREGON FILE #:
IRP BASE STATE /A/C#
Please Indicate the Service Start Month Required
Service Start Month:
Service Start Year:
PLEASE COMPLETE THE UNIT EQUIPMENT SECTION TO PROVIDE US WITH THE REQUIRED TRUCK/FLEET INFORMATION
UNIT EQUIPMENT INFORMATION REPORT SHEET
UNIT #
LICENSE #
YEAR
MAKE
# OF
AXELS
EMPTY
WEIGHT
GROSS WEIGHT
FUEL USED
DATE PURCHASED
PURCHASED PRICE/COST
If you require more unit reporting space click the unit report link for our unit report long-form Unit Report Link
Note to On-line Driver Trip Reporting Clients:
Please provide your preferred User Name and Password in the space below for use submitting your trip Report Information.
My Trip Report Information Submit User Name: My Trip Report Information Submit Password:
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