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MISSOURI DEPARTMENT OF TRANSPORTATION
MOTOR CARRIER SERVICES
PHONE: (800) 877-8499 FAX: (573) 751-7408
www.modot.org/mcs
ESCROW DEPOSIT
THIS FORM MUST BE COMPLETED AND ACCOMPANY EACH DEPOSIT
MAIL THIS FORM TO: MISSOURI DEPARTMENT OF TRANSPORTATION
MOTOR CARRIER SERVICES
P.O. BOX 270
JEFFERSON CITY, MO 65102-0270
STREET ADDRESS 830 MoDOT DR.
JEFFERSON CITY, MO 65101
COMPLETE THE FOLLOWING TO MAKE A DEPOSIT
TO YOUR CURRENT ESCROW ACCOUNT
(Use only escrow account numbers issued after September 2005)
Escrow Account
Number
-
9
Deposit
Amount
$
USDOT Number
Legal Name
Mailing Address
City
State
Zip Code
Contact Person
Telephone Number
TO MAKE A DEPOSIT WITH A DEBIT OR CREDIT CARD CALL 1-800-877-8499
ALL CHECKS ARE TO BE MADE PAYABLE TO:
MISSOURI DIRECTOR OF REVENUE - CREDIT STATE ROAD FUND
(Your cancelled check is your receipt)
Refer to the Oversize and Overweight Permit Regulations Book for information regarding escrow accounts.
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THIS FORM MUST BE COMPLETED AND ACCOMPANY EACH

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Completed 20 July 2020

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