<p>This is only a Permit Application and is not valid for travel. Permits will be issued as ordered by close of the next business day. To immediately obtain a permit, visit our website at www.mdt.mt.gov and use our online permitting system. Please send this in by email to [email protected] or by faxing in to one of the fax numbers listed below.</p><p>“SINGLE TRIP” - PERMIT TYPE REQUEST Revised 06/13/2017 32J LOG NUMBER SELECT TRIP 32J APPROVED APPLICATION PERMIT TYPE OF *IF PERMIT IS FOR A 32J, ALL INFORMATION LISTED BELOW MUST PERMIT MATCH THE 32J APPLICATION SUBMITTED, APPROVED AND ON FILE ELECTRONIC REF NEEDED: WITH MCS*. # </p><p>COMPANY INFORMATION ACCOUNT # USDOT # TIN/FEIN # LEGAL NAME DBA NAME </p><p>BUSINESS ADDRESS (STREET, CITY, STATE, ZIP CODE)</p><p>CONTACT NAME / PERMIT SERVICE PHONE NUMBER</p><p>EMAIL PERMIT TO: FAX NUMBER</p><p>INSURANCE CARRIER POLICY NUMBER EXPIRATION DATE LIABILITY $$</p><p>PERMIT START DATE: PERMIT END DATE: DOES THIS TRUCK HAVE IFTA (INTERNATIONAL FUEL TAX AGREEMENT)? (IF YOU ARE A MT BASED CARRIER YOU DO NOT NEED THIS) YES NO </p><p>VEHICLE / LOAD INFORMATION LOAD DESCRIPTION: ARE TRAILERS, IF APPLICABLE, CURRENTLY REGISTERED? YES NO ENTER THE: TRAILER PLATE STATE OVERALL WIDTH OVERALL LENGTH OVERALL HEIGHT TRAILER LENGTH REAR OVERHANG</p><p>ARE YOU APPLYING FOR: LEGAL WEIGHT or OVERLEGAL WEIGHT (ENTER INFORMATION BELOW)</p><p>LEGAL WEIGHT OVERLEGAL WEIGHT IF LEGAL WEIGHT, WHAT IS THE COMBINED GROSS VEHICLE (ENTER AXLE SPACINGS & WEIGHTS WEIGHT: BELOW). </p><p>Licensing & Permitting Bureau Phone: (406) 444–6130 Fax: (406) 444–7670 or 444-0800 or 444-9263 Page 1 of Term Permit Request Application An Equal Opportunity Employer Motor Carrier Services Division TTY: (800) 335–7592 www.mdt.mt.gov Licensing & Permitting Bureau Phone: (406) 444–6130 Fax: (406) 444–7670 or 444-0800 or 444-9263 Page 2 of Term Permit Request Application An Equal Opportunity Employer Motor Carrier Services Division TTY: (800) 335–7592 www.mdt.mt.gov LEGAL NAME ACCOUNT # </p><p>LIST CURRENT TERM PERMIT NUMBERS WITH MT: OVERSIZE TERM 120 FT NON-DIVISIBLE TERM COMPLETE VIN: PLATE: UNIT: YEAR: MAKE: JURISD.: VEH TYPE: </p><p>AXLE SPACINGS AND WEIGHTS (LISTED IN FEET AND INCHES) VEHIC LE ANAL YSIS NUMB BCL 10MPH REGULAR ER (IF APPLI CABLE ): 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12</p><p>STEERI DRIVES JEEP TRAILER BOOSTER NG</p><p>Make sure each applicable field is completed. Incomplete fields may result in a delay of your permit being processed.</p><p>IS THIS TRUCK APPORTIONED FOR MONTANA; OR IS THIS VEHICLE A MT COUNTY PLATED VEHICLE? YES NO IF YES, AT WHAT WEIGHT? </p><p>IF NOT APPORTIONED FOR MONTANA, ENTER REGISTERED GVW FROM BASE JURISDICTION: ORIGINATION (STATE LINE, CITY, DESTINATION (STATE LINE, CITY, VIA ROUTE: MILES FROM CLOSEST CITY): MILES FROM CLOSEST CITY):</p><p>PAYMENT INFORMATION (CREDIT CARD OR E-CHECK)</p><p>FIRST NAME: LAST NAME: COMPANY NAME: </p><p>BUSINESS ADDRESS (STREET, CITY, STATE, ZIP CODE) PHONE NUMBER</p><p>*CREDIT CARD # TO BE USED: CREDIT CARD EXP DATE: MONTH YEAR</p><p>Licensing & Permitting Bureau Phone: (406) 444–6130 Fax: (406) 444–7670 or 444-0800 or 444-9263 Page 3 of Term Permit Request Application An Equal Opportunity Employer Motor Carrier Services Division TTY: (800) 335–7592 www.mdt.mt.gov NAME ON CREDIT CARD / ACCOUNT: Types of credit cards that MDT accepts are: Visa, MasterCard, Discover and American Express.</p><p>*ELECTRONIC FUNDS: ROUTING #: ACCOUNT #: CHECKING or SAVINGS </p><p>* When Electronic Payment such as credit card or E-Checks are used, the credit card fee is passed onto the carrier.</p><p>MDT Section Only: Completed by: (Name and Uxxxx) Permit Number:</p><p>Licensing & Permitting Bureau Phone: (406) 444–6130 Fax: (406) 444–7670 or 444-0800 or 444-9263 Page 4 of Term Permit Request Application An Equal Opportunity Employer Motor Carrier Services Division TTY: (800) 335–7592 www.mdt.mt.gov</p>