IFTA TOTALS - New Client

Business Information

Business Name

Business Type

Sole Proprietorship Partnership LLC Corporation

Business Contact Name

Business Phone Number

Business Email

Business Address

City

State

ZIP

Mailing Address?

Different Mailing Address

Mailing Address

City

State

ZIP

EIN (If none, skip)

Principal(s) of Business

First Name

Last Name

Title

% Ownership

Home Address

City

State

ZIP

Cell Number

Email Address

Social Security #

Additional Owners

First Name

Last Name

Title

% Ownership

Home Address

City

State

ZIP

Cell Number

Email Address

Social Security #

GVW (Weight of truck and trailer fully loaded)

Interstate (multiple states) Intrastate (just one state)

DOT Number

Number of Trucks

Type of Fuel Used

IFTA License #

IFTA Quarter/Year

1Q (January - March) 2Q (April - June) 3Q (July - September) 4Q (October - December)

Enter the Year from Selected Quarter

Unit #

Miles

DO NOT USE DECIMALS OR COMMAS. PLEASE ROUND TO THE NEAREST WHOLE NUMBER.

EXAMPLE: If your miles are 1000.5 you would round up to 1001. If your miles are 1000.4 you would round down to 1000

ANY FORM THAT DOES NOT HAVE ROUNDED MILES AND GALLONS WILL NOT BE ACCEPTED OR FILED.

IFTA Totals

Miles

Gallons of Fuel

Alabama - AL

Arizona - AZ

Arkansas - AR

California - CA

Colorado - CO

Connecticut - CT

Delaware - DE

Florida - FL

Georgia - GA

Idaho - ID

Illinois - IL

Indiana - IN

Iowa - IA

Kansas - KS

Kentucky - KY

Louisiana - LA

Maine - ME

Maryland - MD

Massachusetts - MA

Michigan - MI

Minnesota - MN

Mississippi - MS

Missouri - MO

Montana - MT

Nebraska - NE

Nevada - NV

New Hampshire - NH

New Jersey - NJ

New Mexico - NM

New York - NY

North Carolina - NC

North Dakota - ND

Ohio - OH

Oklahoma - OK

Oregon - OR

Pennsylvania - PA

Rhode Island - RI

South Carolina - SC

South Dakota - SD

Tennessee - TN

Texas - TX

Utah - UT

Vermont - VT

Virginia - VA

Washington - WA

West Virginia - WV

Wisconsin - WI

Wyoming - WY

Grand Totals

Miles

Fuel

Miles per Gallon

*MPG Typical Range - Trucks 5-8, Pickups 8-12

File my IFTA taxes $85 (1-2 trucks, each additional truck $15) Renew my IFTA license and order new decals $85 Close my IFTA account $50 File my quarterly weight distance taxes $27 each

KY NM OR NY

Unit #

Miles

*Please attach separate page for more than five trucks

Unit #

Miles

*Please attach separate page for more than five trucks

Toll Miles

Credit Card Information

Name on Card *

Credit Card Number *

Exp. Date *

CVC *

By submitting you agree to have Authority Express LLC file and charge you for your IFTA taxes and/or Weight Distance taxes. You will also be responsible for any state fees or taxes. Any fees under $100 will be paid automatically using the payment information on file unless you request otherwise.