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LB Safety Operations Services, Inc. 931-657-5667 New Mexico Application Form
Company Name(DBA): Address: City: State: Zip: Phone: Fax: Email: DOT#: FEIN#: Contact Name: Title:
Vehicle Information: Vehicle Year: Make Vin # Unit # Gross Weight Owned Leased Title State Plate # Do you have other vehicles permitted in New Mexico? If YES, New Mexico WD#:
Payment Method: Payment made Online Will Call with CC Info. Please call for CC Info. New Mexico Application Charge will be $40.00, additional vehicles $6.00 each. Credit card payment will be required and can be made online or by phone.
Signature Date Please Print, Sign And FAX 931-657-5668 *New Mexico Application can take up to 24 business hours to process.*
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Additional Vehicles Vehicle Information: Vehicle Year: Make Vin # Unit # Gross Weight Owned Leased Title State Plate # Vehicle Information: Vehicle Year: Make Vin # Unit # Gross Weight Owned Leased Title State Plate # Vehicle Information: Vehicle Year: Make Vin # Unit # Gross Weight Owned Leased Title State Plate # Vehicle Information: Vehicle Year: Make Vin # Unit # Gross Weight Owned Leased Title State Plate #
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