test-form - New York Highway Use Tax

Carrier Info Confirm Your Official Representative
Registration Details Additional Carrier Info
Vehicle Details Number of Registered Vehicles
Payment Info Pay to Complete Registration

Carrier Information

Step 1 - 4

Your USDOT*

Email Address*

Business Phone Number*

Who is creating this registration?

Name (First & Last)*

Position*

EIN*

Street

City

State

Zip Code

Mailing Address is the Same as Physical Address

Mailing Address

Business Type

Sole Proprietor

Corporation

Partnership

LLC

LLP

Other

Registration Details

Step 2 - 4

Name and Location where tax and mileage records are available for audit

Name of Custodian of Records*

Phone Number*

Street

City

State

Zip Code

Each Principal Officer of a Corporation or Partner (THIS COULD HAVE ONE OR MULTIPLE PEOPLE LISTED)

Name (First & Last)*

Position*

SSN*

Street

City

State

Zip Code

Check if this application is signed by an employee who is not an officer, partner, member, or proprietor.

Check if this application is signed by an agent, service, or other representative.

Don't have a UCR Certificate? Get yours at UCR.online

Name of person signing

Title

Date signed

06/07/2023

Signature

Canvas is not supported.

Vehicle Details

Step 3 - 4

VIN*

License Plate*

Issued State*

Unit#*

Vehicle Year*

Make*

Model*

Type of fuel used*

GVW*

Unloaded Weight*

Truck status*

Number of axels*

No.	Make & Model	Licence Plate#	GVW	Action
START ADDING VEHICLE
Total Cost: $

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

Street

City

State*

Zipcode

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 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

New York Highway Use Tax (HUT)Form