New Mexico Distance Tax (WDT) Form

Step 1. Form Step 2. Payment

USDOT# Number:

Email address:

Business Phone Number:

Who is Filing the Form?

Legal name:

DBA:

Physical country:

Physical state:

Physical city:

Physical address:

Physical zip code:

Mailing Address is the Same as Physical Address.

Mailing country:

Mailing state:

Mailing city:

Mailing address:

Mailing zip code:

Billing Address is the Same as Physical Address.

Billing country:

Billing state:

Billing city:

Billing address:

Billing zip code:

Are You the Owner of the Company?

Company owner name:

Carrier Tax ID type:

Carrier Tax ID:

Business Type:

Other Business Type:

Do you Have a NMWD Account?

NMWD Account Number:

I certify that I am the authorized holder and signer of the credit card reference above. I certify that all information above is complete and accurate.

I hereby authorize collection of payment for all charges as indicated above. Charges may not exceed the amount listed above in the “TOTAL COST” field. I understand this is only for up to this amount on the date listed below in the "DATE SIGNED" field. If additional charges are going to be authorized a new form will have to be completed.

The “TOTAL COST” includes all Federal, State and Local Government fees.

I hereby, acknowledge and agree that after the charges are authorized a DOT OPERATIONS INC agent is assigned in 15 minutes to run the order. Once the agent is assigned the charges become non-refundable.

Signature:

Permit Starting Date:

Registered weight:

Route Type:

Trip:

Round Trip

One Way Trip

Entrance Point:

Start Point:

Exit Point:

I agree with Privacy Policy and Terms and conditions

Your signature:

Total cost: $ 0

New Mexico Distance Tax (WDT) Form

Vehicle details

Your signature: