(used primarily for manufactured homes)
Page 2 – Check the appropriate box for each type of blanket permit you are requesting.
INSTRUCTIONS FOR COMPLETING A BLANKET PERMIT APPLICATION
USDOT #: Enter your U.S. Department of Transportation Number. If your operation does not require a USDOT number, enter
“XX”. If you don’t know if a USDOT number is required, call the FMCSA at 573-636-3246 or visit www.safersys.org
Contact Person: Enter the name of the person we can call with questions about the application.
Contact Telephone Number: Enter the contact person’s telephone number.
Account Number: Enter the account number assigned to you by MoDOT Motor Carrier Services.
Payment Type: Check a box for escrow account, cash, check or specific credit card. If using a credit card, for security reasons, do
not write the card number on the application. A MoDOT employee will contact you for the information verbally.
Legal Name: Enter your legal name.
NOTE: If you have a MoDOT account number or ordered a permit in the past six months, skip to the Start Date section.
DBA Name: If your business is a sole proprietorship and you are doing business with a fictitious name, enter your business name. If
you are a Missouri-based carrier, you must register this name with the Secretary of State office. You may contact the SOS office by
calling 866-223-6535 or visiting www.sos.mo.gov.
Federal Identification/Social Security Number: Enter your FEIN if applicable. If not, enter your social security number. State law
requires FEIN or Social Security Numbers of sole proprietorships. You must provide a FEIN or Social Security Number to obtain a
permit.
Customer Type: Check one box. Private or For Hire.
Check one box. Interstate Carrier, Intrastate Carrier or Both.
Insurance Information: Insurance Company Name, Policy Number, Expiration Date and amount of coverage (check one box).
Physical Address: Enter the address of your principal place of business.
Mailing Address: Enter your mailing address if it is different from the physical address.
Start Date: Enter the date you want your permit to start.
Send Permit How?: Enter the fax number, mailing address, and/or the e-mail address where you want the permit delivered.
Power Unit: Enter the license number, state it is licensed in, complete vehicle identification number, year and make. Check one box
for power unit type. Examples follow:
Toter Truck Truck-Tractor
Revision: If you want to revise a current year permit, check yes and provide the original permit or application number and original
license number, otherwise check no.
Emergency Response: If under own power, enter serial number and the serial number.
Individual Axle Weights: Enter weights for each axle in pounds.
Axle Space: Enter each individual axle spacing in feet and inches.
Water Well Drill Rig or Concrete Pump Truck: Check appropriate box. Enter make, serial number, overall width and length.
Individual Axle Weights: Enter weights for each axle in pounds.
Axle Space: Enter each individual axle spacings in feet and inches.
Certification: Print your name and the date of application. Sign the form and provide your business title, (i.e. president, owner or
partner).
