Application For IRP, Permit & Fuel Tax

IMPORTANT: YOU MUST SCROLL DOWN TO SIGN, THEN HIT "AGREE & SIGN" BUTTON

APPLICATION FOR SERVICES

IRP AND FUEL TAX REPORTING ***ORIGINAL APPLICATION***

Date of Application: September 20, 2024

GENERAL COMPANY INFORMATION

Business Legal Name or Individual Name:
DBA:
Business Address: ,

Phone Number: Fax Number:
Email Address:
Website:

Federal ID#:
Type of Business:

How did you hear about Road Ready?

PERSON TO CONTACT REGARDING IRP AND/OR PERMITS

Name:
Email:
Phone:
Fax:

Preferred Method of Contact:

BANK INFORMATION (FOR IFTA/CDTFA PURPOSES IS MANDATORY)

Name of Bank or Financial Institution:

Location, City and State: ,

STATUS OF CITIZENSHIP

Are you a U.S. Citizen:

Are you a U.S. Resident:

MAILING INFORMATION

Mailing Address (if different from above):
,

OFFICERS/PARTNERS/OWNER

President/Partner/Owner:
Social Security #:
Drivers License:
State:

Address: ,

Name:
Phone # (Day):
Phone # (Night):

PERMITS

Please list all account numbers for all permits that your company currently holds:

US DOT#:
DOT PIN:
MC/ICC#:
MC PIN:
REQUESTER CODE#:
HAZARDOUS MATERIALS #:
IFTA#:
NM:
KYU:
NY:
OR:

If leased to Carrier
Name:
DOT#:
Fed ID:

TYPE OF CARRIER

Please place an "X" next to type of carrier:

Type of Carrier:
Do You Haul:

UNIT AND DRIVER INFORMATION

# of Power Units:
# of Trailers:
# of Drivers Employed By Your Company:

PRODUCTS HAULED

Please list all products your company hauls:
Do you haul hazardous waste products:

EQUIPMENT TERMINAL LOCATION IS MANDATORY

Terminal (where truck(s) are parked)

Address: ,

Person to Contact at Location:
Phone:

EMERGENCY CONTACTS

Name:
Phone # (Day):
Phone # (Night):

INSURANCE

Please attach a copy of your insurance card or certificate

Insurance Company:
Agent:
Phone Number:
Fax:
Do you have liability insurance?
Do you have Workers Compensation Insurance?

AUTHORITIES REQUESTING

Registration Requesting:

State (if selected):

Federal Authorities Requesting:

California Permits Requesting:

PERMITS REQUESTING

The following permits were selected:

Other (if selected):

DRUG & ALCOHOL PROGRAM

Are you enrolled in a drug & alcohol program?

FUEL TAX REPORTING

I would like Road Ready to file my quarterly fuel taxes:

SERVICE FEE PRICE SHEET

IRP Account (New Account, New Fleet, Renewal)

New Account $TBD*
Renewal $ TBD*

*Based on number of trucks

IRP Supplements

Add Tractor $150.00

Duplicate Items and Corrections

Plates (IRP) $87.00
Sticker $87.00
Cab Card Corrections $87.00

Quarterly Fuel Tax Reporting

Power Units $79.00 per unit per quarter *
OR, NY, CT Monthly Tax $45.00
Yearly Ad Valorem Tax (Property Tax)* $79.00 - 150.00 *

*Based on number of trucks

New Account Set Ups & Renewals-Authorities & Permits

Permit Set Ups $79.00/ each permit
EIN Application $79.00
Oregon Set Up with Bond $185.00
MC/ICC./DOT - Original Set Ups $175.00 plus $50.00 for BOC3
CA/MCP - Original Set Ups $185.00

Add Units - Permits & Filings

IFTA Permit $75.00
New Mexico $75.00
New York $75.00
Oregon $75.00
Kentucky, Arkansas $75.00
UCR $79.00 - $500.00*
2290 $90.00 - 300.00*
Duplicate & Replacement Permits $35.00

*Based on number of trucks

Misc.

Audits & Counseling $95.00 per hour
VIN Verifications $80.00 - $95.00
DMV Vehicle Printouts $18.00
DMV NMVITIS report $10.00

*** Federal Express, GLS and/or UPS will be mailed out at client’s expense. If you would like Road Ready Registration, Inc. to use your account number, please inform us immediately. ***

The fees listed above are for Road Ready Registration service fees only. Service fees must be paid Upon receipt for the first six months, unless otherwise negotiated. All DMV fees quoted are estimated fees only. Actual DMV fees are determined by the state. Any past due invoices will be assessed interest at 1.5% per month.
Service fees listed above are subject to change without notice.

SERVICE AGREEMENT

This agreement is made by and between Road Ready Registration Entities, a California Corporation with it principal place of business located at 9561 PITTSBURGH AVE RANCHO CUCAMONGA, CA 91730 and with its principal office located at , .

Road Ready Registration Entities provides various Title & Registration Services, Renewals, Interstate Commercial Licensing, Permits, Fuel Tax Reporting, Authority Filings, and DOT Drug & Alcohol Services.

Now, therefore, for good and valuable consideration, the parties agree and follow:

Article 1 (Term) – This Agreement will become effective on the date on which it is signed by a representative of the Company and the Title & Registration Services, Renewals, Interstate Commercial Licensing, Permits, Fuel Tax Reporting, Authority Filings, and DOT Drug & Alcohol Services has been completed by the Customer. This agreement shall remain in effect for one (1) year.
Article 2 (Services) – Subject to qualifying, Road Ready Registration Entities shall provide the Customer Title & Registration Services, Renewals, Interstate Commercial Licensing, Permits, Fuel Tax Reporting, Authority Filings, and DOT Drug & Alcohol Services at the rate of agreed upon price sheet, (please see attached price sheet).
Article 3 (Indemnification) – Road Ready Registration Entities is an independent contractor providing the Customer with Title & Registration Services, Renewals, Interstate Commercial Licensing, Permits, Fuel Tax Reporting, Authority Filings, and DOT Drug & Alcohol Services provided herein. The Customer agrees to indemnify, defend and hold Road Ready Registration, Inc., its officers, directors, agents, employees and other related parties harmless from and against any and all liabilities, damages, losses, expenses, claims, demands, suits, fines, or judgments that include reasonable attorney’s fees, costs and expenses, incidentals thereto, which may cause suffrage or may come into existence as a claim that is legally enforceable and may accrue for charges to or recoverable from any customer or customers’ client indemnitee, by reason of any claim arising out of or relating to any act or error or omission, or misconduct of Road Ready Registration Entities, its officers, directors, agents, employees or subcontractors.
Article 4 (Force Majeure) –Road Ready Registration Entities will not be responsible or liable to the Customer for failure or delay in performance, which results from or is due to, directly or indirectly and in whole or part, any cause or circumstances beyond the reasonable control of Road Ready Registration Entities.
Article 5 (Payment Terms) –Payment is due upon receipt of services, unless other arrangements have been made in writing. Every 30 days a letter will be generated for late payments. Any open balances over 90 days late will be subject to collection through Road Ready Registration Entities collection agency.
Article 6 (Fixed Pricing) –No increase or decrease of fees will be automatic. A minimum of 30 days written notice is required. Road Ready Registration Entities is not responsible for any oral instructions.
Article 7 (Applicable Law) – This Contract will be construed under the laws of the State of California.
Article 8 (Termination and Renewal of Agreement) – If this Agreement is suspended or terminated for any reason by the Customer, the money received shall be deemed earned. It is understood by all parties and it’s employees that this agreement shall remain in effect until cancelled by either party, with a thirty (30) days written notice.
Article 9 (Cancellation) – If the account is 90 days or older Road Ready Registration Entities can choose to cancel your account, until your account is brought current.
Article 10 (Terms and Conditions) –The only terms and conditions that will be applicable to the interpretation of this agreement are those issued by Road Ready Registration Entities, of Rancho Cucamonga, California.

Your digital signature of this Service Agreement below indicates your acceptance of the Terms and Conditions.

***OFFICE USE ONLY***
Date Received: _________________________________________ Rep: ___________________________________________________
Customer Folder Type: Brown Manilla Purple Green
Copies Given To: _______ Office Manager _______ Accounting

IMPORTANT: YOU MUST SIGN BELOW, THEN HIT "AGREE & SIGN" BUTTON IN BLUE CORNER

YOUR SUBMISSION WILL NOT BE DIGITALLY SIGNED UNLESS THIS IS COMPLETED

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Timestamp

Audit

December 8, 2020 10:16 pm PDT

Application For IRP, Permit & Fuel Tax Uploaded by Natalie Banks - managers2@roadreadyreg.com IP 68.111.90.210

January 28, 2021 3:21 pm PDT

Road Ready Registration - managers@roadreadyreg.com added by Natalie Banks - jasonweamer@gmail.com as a CC'd Recipient Ip: 68.228.77.125

March 3, 2021 12:32 pm PDT