Form Crf-Ifta - Ifta Motor Carrier Registration Application
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CRF-IFTA (10/10)
GEORGIA DEPT. OF REVENUE
PROCESSING CENTER -
MOTOR VEHICLE/IFTA
FOR OFFICE USE ONLY
P.O. BOX 740382
ATLANTA, GA 30374-0382
Rejects
404-968-3800
IFTA MOTOR CARRIER REGISTRATION APPLICATION
Motor Fuel
(Please Read Instructions Before Completing)
Sales Tax
Corp
NEW REGISTRATION
Withholding
RENEWAL
MCIT
1. STATE TAXPAYER IDENTIFIER:
2. FEI OR SSN (Required)
3. LEGAL BUSINESS NAME
4. LOCATION ADDRESS (Required)(NO P.O. BOX)
5. DBA NAME
6. MAILING ADDRESS (Required)
7. BUSINESS STRUCTURE:
SUB-CHAPTER S CORPORATION
SOLE PROPRIETOR
CORPORATION
PARTNERSHIP
LIMITED LIABILITY COMPANY
LIMITED LIABILITY PARTNERSHIP
8. US DOT NUMBER (REQUIRED)
9. YEAR FOR WHICH APPLICATION IS MADE
PHONE NUMBER (REQUIRED)
10. HAVE YOU EVER BEEN LICENSED UNDER IFTA IN ANOTHER
11.
(
)
STATE?
YES
NO
IF YES, WHICH
Area Code
STATE?
13. LIST YOUR GROSS VEHICLE WEIGHT (GVW)
12. IRP ACCOUNT NUMBER
14. LEASED VEHICLE
YES
NO
15. DO YOU TRAVEL OUTSIDE GEORGIA?
YES
NO
MOTOR CARRIER IDENTIFICATION MARKERS
17. NUMBER OF GASOLINE POWERED VEHICLES
16. NUMBER OF DIESEL POWERED VEHICLES
19. OTHER FUEL TYPES
18. NUMBER OF LP POWERED VEHICLES
20. TOTAL NUMBER OF MOTOR CARRIER DECAL SETS:
X $3.00 PER SET = $
Revision Date CRF-IFTA (10/10)
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Parent category: Financial