Your Name (required)

Your Email Address (required)

Your Phone Number (required)

Applicant Name (Individual or Corporation)*

President/Owner's Name (if a corporation or LLC)*

Title (President, Owner, Manager, etc.)

Current Address

Phone Number*

Email

List VIN numbers of all vehicles that you need to pay HWY Use Tax for. (Double check all VIN numbers)

I am aware that by submitting this form I give my permission to DL FREIGHT Inc to process the HWY Use Tax application on my behalf.*
Yes

Additional Notes (optional)