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Contact Information


Name
Company
Address
City
State/Prov.
Zip/Postal Code
ie. 12345 or 12345-1234 or J2K4L3
Telephone
ie. (800)123-4567
Fax
ie. (800)123-4567
E-mail


Additional Information

Number of IFTA trucks:
Are all vehicles diesel?
Base IFTA license:

Areas of travel:


CanadaUS
AB
BC
MB
NB
NL
NS
ON
PE
QC
SK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
IA
  ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
  MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
  NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
  TX
UT
VA
VT
WA
WI
WV
WY

If you travel in NY which reporting method do you presently use?

Data/Information to be supplied

1. Distance Information



2. Fuel Information



3. Toll Information
(eg. NY thruway statement, EZ Pass statement)


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