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Oversized Permits

Fill out all applicable information. Incomplete forms will slow permit processing.

Contact Information
First Name Last Name
Email Address
Work Phone Ext Phone Other

123-456-7890
Fax  
 
   
Carrier Information
Legal Name
 

Individual or Company Name
ending in Inc, Ltd, LLC, etc.
DBA
 
Physical Address
Mailing Address
City
State
Postal Code
   
ICC #
DOT#
FID/SSN#
FID=xx-1234567 or SSN=123-45-6789
TFID#
TFID=xx-1234567
   
Insurance Information
Insurance Carrier Name
Address 1
Address 2
City
State
Postal Code
 
Policy #
Date Effective
Expiration Date
   
Power Unit Information
Driver's Name
 
Unit # Year Make  
 
 
Serial Number/VIN (ALL CAPS) License Plate #/State
 
Empty Weight Registered GVW # Axles  
 
     
Trailer Information
Unit # Year Make  
 
 
Serial Number/VIN (ALL CAPS) License Plate #/State
 
  Ft In   Ft In   Ft In
L W H
     
Load Information
Load Description

Include Make, Model & Serial Number
       
Load Weight
Load Dimensions
  Ft In   Ft In   Ft In
L W H
       
Overall Dimensions & Weights
(Truck/Tractor, Trailer & Load)
Overall
  Ft In   Ft In   Ft In
L W H
Overhang Rear Front
 
Total Gross Weight Total # Axles
       
Axle Spacings Axle Weights Tire Width No. of Tires
1-2 1 1 1
2-3 2 2 2
3-4 3 3 3
4-5 4 4 4
5-6 5 5 5
6-7 6 6 6
7-8 7 7 7
8-9 8 8 8
9-10 9 9 9
10-11 10 10 10
11-12 11 11 11
12-13 12 12 12
13-14 13 13 13
14-15

14

14 14
15-16 15 15 15

16-17

16 16 16
17-18 17 17 17
18-19 18 18 18
19-20 19 19 19
    20 20 20
 
Routing Information
Load Origin

Physical Address
City
State
 
Load Destination

Physical Address
City
State
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
State Route Eff. Date
 
Billing Information
Required only if different from company address.
Billing Name
Billing Address
 
City
State
Postal Code
   
Payment Information
Credit Card Number 
Exp Month/Year
   
Card Type
Card Holder
Security Code
   
Additional Information

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