Application For Florida Motor Fuel Use Tax (Fut)
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1
2STATE OF FLORIDA
INDICATE
DIVISION OF MOTOR VEHICLES
ACCOUNT TYPE
BUREAU OF MOTOR CARRIER SERVICES Room A110
IFTA
TALLAHASSEE, FLORIDA 32399-0625
(904) 488-6921
FLORIDA FUEL USE
(NON IFTA)
APPLICATION FOR
FLORIDA MOTOR FUEL USE TAX (FUT)
OR
INTERNATIONAL FUEL TAX AGREEMENT (IFTA)
CREDENTIALS
1.a Owner's Name:
b. Business Name (if different):
2. Business Location Address:
3. Business Mailing Address:
4. Contact Person:
5. Telephone Number:
6. Account Number:
7. Business Telephone Number:
Federal Employer Identification # or Social Security #
8. Check Type of Ownership:
Individual
Corporation
Other
Partnership
9. List Owner, Partners or Corporate Officers:
Name
Address
Title
Social Security #
Telephone #
10. If registered with Florida Department of Revenue under Chapter 206, as a Special Fuel Dealer or Motor Fuel Distributor, give
license number(s): Special Fuel:
Motor Fuel:
Effective Date:
11. List Florida International Registration Plan (IRP) Account Number:
12. Types of fuel used (check all that apply):
Diesel
Propane
Gasohol
Natural Gas
Gasoline
13. Have you ever been licensed in another IFTA juridsiction?
Yes
No
No
14. Has your license ever been revoked?
Yes
PLEASE COMPLETE REVERSE SIDE OF THIS APPLICATION
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
NEW APPLICANT ONLY
FLORIDA FUT & IFTA DECAL ORDER FORM
15. Indicate the number of qualified motor vehicles requiring decals for IFTA or FUT. Only one type may be requested.
DECAL YEAR ORDERED
FEI/SS #
NAME
IFTA DECAL SETS NEEDED
FUT DECALS NEEDED
ADDRESS
CITY/STATE/ZIP
DRIVE-A-WAYS NEEDED
x $4.00
FEE
Authorized Signature
TOTAL AMOUNT DUE
Telephone Number
HSMV 85008 (Rev. 1/96) S
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