Washington trucking Permit Form

USDOT# Number:

Email address:

Business Phone Number:

Who is Filing the Form?

Legal Business name:

Permit Starting Date:

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

I hereby authorize 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 OPERATIONS INC agent is assigned in 15 minutes to run the order. Once the agent is assigned the charges become non-refundable.

Signature:

Save signature Please sign on the designated area