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LB Safety Operations Services, Inc. 931-657-5667 New York HUT Permit Application Order Form
Company Name: Address: City: State: Zip: Phone: Fax: Email: MC #: DOT#: Contact Name: Title: Vehicle Information: Vehicle Year: Make Title State Vin # Unit # Plate # Unloaded Weight Gross Weight Owned Leased Truck Tractor : Diesel Gas : Number Axles Transports Fuel Yes No Do you have other vehicles permitted in New York? If YES, New York Tax ID # Payment Method: Payment made Online Will Call with CC Info. Please call for CC Info. I would like a free quote for receiving up to 95% advances within 24hours on your freight invoices with no contract terms, no application fees, no startup fees, unlimited credit checks, On-line account access, and more?: Yes No The Charge is $75.00 for New Account Registration and permit. Credit card payment will be required and can be made online or by phone, unless you have made prior billing arrangements with our company.
Signature Date Please also complete page 2 ( New Account Registration Form) then Print, Sign And FAX 931-657-5668 NY HUT Normally Processes by Next Business Day, Slight delays from New York are possible.
HUT/AFC New Account Registration Form 1. Identification Number Federal Employee Identification Number (EIN) Suffix, if any OR Social Security Number (SSN) 2. Legal Name 3. Type of business Sole Proprietorship Corporation Partnership Limited Liability Corporation (LLC) Limited Liability Partnership (LLP) 4. Names, titles, SSNs, and residence addresses of principle officers of corporation or of members, partners, owners, ect. Name Title SSN Address City State Zip Name Title SSN Address City State Zip Name Title SSN Address City State Zip 5. Office where fuel and mileage records are available for audit Name Phone Address City State Zip |