Application Form

1. Customer Information

Contact Name

Company

Phone

FEIN/Tax ID

IFTA License Number

USDOT Number

Driver's License (If Individual)

2. Load Information

Load Date

Bill of Lading

Load Year/Make

Load Model

Load Serial Number (Required when the load is motorized)

Load Weight

Load Width

Load Height

Load Length

Detailed Load Description:

3. Vehicle Information

Truck Year:

Make / Model:

Licensed GVW:

Axles:

State:

Unit #:

Empty Weight:

Truck License Plate #:

Truck VIN# (17 Digits):

Trailer Year:

Type / Length

State:

Make:

Axles:

Unit #:

Empty Weight:

Trailer License Plate #:

Trailer VIN# (17 Digits):

Overhang Front

Overhang Rear

Distance from Kingpin to Last Axle:

Total Weight:

Overall Width:

Overall Height:

Overall Length:

Axles:

Number of Tires

T -1

T - 2

T - 3

T - 4

T - 5

T - 6

T - 7

T - 8

T - 9

Axle weights

AW - 1

AW - 2

AW - 3

AW - 4

AW - 5

AW - 6

AW - 7

AW - 8

AW - 9

Axle Numbers:
Axle Spacings*: (ft-in)

1 - 2

2 - 3

3 - 4

4 - 5

5 - 6

6 - 7

7 - 8

8 - 9