Fillable FROM:(check one) Motor Carrier (Virginia Department of Motor Vehicles)

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FROM:(check one) Motor Carrier (Virginia Department of Motor Vehicles)

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MOTOR CARRIER FAX COVER SHEET
MCS 100 (07/01/2010)
Motor Carrier
Customer Service Center
(DMV USE ONLY)
LOCATION CODE
TELEPHONE NUMBER
CUSTOMER SERVICE REPRESENTATIVE NAME
CARRIER NAME
IRP
ACCOUNT NUMBER
FLEET NUMBER
ASSESSMENT
PAYMENT RECEIPT
INVOICE
IFTA
ACCOUNT NUMBER VIRGINIA IRP ACCOUNT NUMBER
RDT 121, QUARTERLY TAX RETURN
PAYMENT RECEIPT
ACCOUNT INFORMATION
TOTAL NUMBER OF PAGES
(including this cover sheet)
FAX NUMBER
TELEPHONE NUMBER
CARRIER FAX NUMBER
FAX SENT DATE
(mm/dd/yyyy)
CSC NAME
FROM:(check one)
TO: DMV Motor Carrier Processing Center FAX: 804-367-1073 TELEPHONE: 804-249-5140
OTHER (describe)
OTHER (describe)
Purpose: Use this form as the cover sheet to fax forms/documents to DMV, Motor Carrier Services.
Instructions: Motor carrier attaches completed cover sheet to the items to be faxed. Items may be faxed directly to DMV or
may be delivered to any Customer Service Center (CSC). The CSC will fax the items to DMV headquarters.
ASSESSMENT
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( )
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FROM:(check one) Motor Carrier (Virginia Department of Motor Vehicles)

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Completed 2 November 2020

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