Weight-Mile Tax Enrollment Application Form

Weight-Mile Tax Enrollment Application Form
Please complete this form to enroll your business and vehicles in the Weight-Mile Tax program.
Business Name
Federal Employer Identification Number (EIN)
Business Type
Contact Person Full Name
First NameLast Name
Contact Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Number of Vehicles to Enroll
Vehicle Information
Estimated Annual Miles Driven in the State
Should be Empty: