LB Safety Operations Services, Inc. 

931-657-5667
Fax 931-657-5668
 

New York HUT Permit Application Order Form

Company Name:

Address:

City:   State:   Zip:

Phone:   Fax:  

Email:

FEIN:   MC #:   DOT#:

Are you an/a: Individual  Corporation  Partnership  LLC LLP Other____________________

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  

New York HUT Permit Charge is $49.00. 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 Print, Sign And FAX  931-657-5668   NY HUT Normally Processes by Next Business Day, SLIGHT DELAYS FROM NEW YORK ARE POSSIBLE