Vermont Waste Transportation Vehicle Report Form Page 2
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1
2Name of Business (continued): ____________________________________________________________________
You must provide the following information for each vehicle to be included in your waste transporter permit.
VEHICLES PERMITTED
1.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
2.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
3.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
4.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
5.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
6.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
7.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
8.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
9.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
10.
Vehicle Make, Model, Type:
# of Axles:
Color:
Year:
VIN#:
Registration#:
State:
Please use additional sheet if needed.
APPLICANT’S SIGNATURE: ______________________________________DATE:____________
FOR DEPARTMENT USE ONLY
Fee Amt. Rec’d.:
Vehicle Report Form &
Check#
Processed check
Corporation
Scanned &
check
saved
☐Yes ☐ No
received on:
/
/ 2016
$________________
_______________
___/___/2016
__/__/_2016
# of stickers__________,
Incomplete, due to insufficient
Approved by:
and approved permit mailed
paperwork, or other reason:
to hauler on
Explain: _________________________
__________________________________________
____/______/_____2016
_______________________________
Date:___________________________
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