NAME
SHIPPER
ID NUMBER (VAHPS ID, FEIN, OR SSN)
HP 403 (10/27/2020)
VIRGINIA HAULING PERMIT ADDENDUM
ADDITIONAL AXLE
PURPOSE: Use this form to provide additional axle information when submitting Virginia Single Trip Superload Hauling
Permit Application (HP 400) or the Virginia Blanket Hauling Permit Application (HP 401).
INSTRUCTIONS: Mail the completed form to DMV Hauling Permits, P.O. Box 26302, Richmond, VA 23260 or you may fax the
completed form to the number above.
Telephone: (804) 786-2787
Fax: (804) 367-1003
Web site: www.dmvNOW.com
DMV USE ONLY
RECEIVED DATE (mm/dd/yyyy) RECEIVED NUMBER
ADDITIONAL WEIGHT AND AXLE SPACING
DATE (mm/dd/yyyy)
SIGNATURE
I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are
genuine, and that the information included in all supporting documentation is true and accurate. I make this certification and
affirmation under penalty of perjury and I understand that knowingly making a false statement or representation on this form is a
criminal violation.
Prepared by permit service company
COMPANY NAME
ID NUMBER (VAHPS ID, FEIN, OR SSN)
AXLE 10 11 12 13 14 15 16 17
WEIGHT
DISTANCE
(between axles)
___ ft ___ in ___ ft ___ in ___ ft ___ in ___ ft ___ in ___ ft ___ in ___ ft ___ in ___ ft ___ in
___ ft ___ in
AXLE 22
WEIGHT
DISTANCE
(between axles)
NAME (print)
SIGNATURE
9
(weight stated on
HP application)
18 19 20 21 23 24 25 26
___ ft ___ in ___ ft ___ in __ ft __ in ___ ft ___ in ___ ft ___ in ___ ft ___ in ___ ft ___ in ___ ft ___ in ___ ft ___ in
lbs
FAX NUMBERTELEPHONE NUMBER
17
(weight
stated above)
lbs lbs lbs lbs lbs lbs lbs
lbs lbslbslbslbslbslbslbslbs
