503 3786699 form 2025

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The document outlines a billing authorization program by the Oregon Department of Transportation's Motor Carrier Transportation Division (MCTD) for carriers in good standing. It allows company representatives or drivers to charge specific fees to their account, including temporary passes and trip permits. Authorization must be provided in writing or via phone before issuing receipts. Monthly statements will be sent, and unpaid fees may incur penalties. A signature from an authorized representative is required to participate.

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Click ‘Get Form’ to open the 503 3786699 form in the editor.
Begin by entering your business name in the designated field. This identifies the entity responsible for the billing authorization.
Fill in your mailing address, including street, city, state (abbreviated), and ZIP code. Accurate information ensures you receive all correspondence related to your account.
Input your MCTD account number. This is crucial for linking your billing authorization to your existing account.
Review the fees that may be charged under this program, such as Temporary Pass and Trip Permit fees. Ensure you understand these before proceeding.
An authorized company representative must sign at the bottom of the form. This signature confirms that they authorize drivers or representatives to charge fees to your account.
Finally, add the title and date next to the signature for proper documentation before submitting the form.

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