WV DMV Skip the Trip!

Contact Information

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

Email:

Owner, Partner(s), or Corporate Name (Legal Name):

What Type of Organization in this Business?:

Account #:

Please provide your Federal Employer ID or SSN.

Federal Employer ID:

SSN:

Number of Decals ($5 for vehicle):

Business Information

Name under which business is conducted:

Physical location (Must be a physical address, PO Box not acceptable):

Has this address changed in the last year?:

Yes No

City:

State:

County:

Zip:

Contact Person:

Phone Number:

Fax Number:

WV DOT Number:

IRP Account Number:

Is your mailing address the same as your physical address?:

Yes No

Mailing Address:

lease enter your Mailing Address.

City:

Please enter your Mailing City.

State:

Please select your Mailing State.

Zip:

Please enter the Mailing Zip

County:

Please enter your Mailing County.

Has this address changed in the past year?:

Yes No

Please make a selection.

APPLICANT AGREES, UNDER PENALTY OF PERJURY, THAT THE INFORMATION GIVEN ON THE IFTA APPLICATION IS, TO THE BEST OF THEIR KNOWLEDGE, TRUE, ACCURATE, AND COMPLETE.

User Acknowledgement

Name of Taxpayer:

Date:

Email Address:

Phone Number:

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West Virginia Department of Transportation

Renewal Application For Motor Carrier

Contact Information

Business Information

User Acknowledgement