Department of the Secretary of State
Maine Bureau of Motor Vehicles
72 Consecutive Hour
Trip Permit Application
Permit Information: 

Effective Date & Time |
Expiration Date & Time |
/ |
/ |
I am applying for the following:
IRP Trip Permit ($25.00 + $3.00 Fax Fee)
IFTA Fuel Trip Permit ($50.00 + $3.00 Fax Fee)
Combination IRP/IFTA Trip Permit ($75.00 + $3.00 Fax Fee)

Carrier Information: 

Registrant Name: ________________________________________________
Address: _______________________________________________________
City: _____________________ State/Province: _____ Postal Code: ________
Carrier Responsible for Safety US DOT Number:1 _______________________
Vehicle Information: 
(A copy of the Valid Registration must be provided.)
Year |
Make |
Maine Reg. Wgt. |
Axles VIN Number |
|
|
|
|
Base Jurisdiction |
Plate Number |
Unit Number |
|
|
|
|
|
|
Contact Information:

Person Requesting Trip Permit |
Phone Number |
|
|
Fax Trip Permit To (Name) |
Fax Number |
1If you are leased to another carrier, you are required to provide a copy of the lease agreement.
**The following payment information MUST be provided**
Type of card: (please circle one) VISA Mastercard
Account Number: __________________________ Exp. Date: ______________
Cardholder Name: _________________________________________________
Billing Address: ___________________________________________________
Telephone Number (Cardholder): _____________________________________
Signature: ________________________________________________________
REVISED 7/06/2012
101 Hospital Street, 29 State House Station, Augusta, ME 04333-0029
Phone (207) 624-9000 Ext. 52135 Fax (207) 624-9086 TTY Users call Maine relay 711
www.maine.gov/sos/bmv/commercial Email: meirp@maine.gov