ADMIRAL PERMIT APPLICATION FORM    Smiley facev2.7
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     		Trip Number # *
 Truck Make *     
 Year ex: 99
 Plate # *
 Plate St. ex:NM *
 Truck VIN # *

First Name *8 characters max
Last name *10 characters max
 Trailer Make *   
 Trailer Year *
 Plate # *
 Plate State *
 Trailer VIN # *
Would you like to receive your permits via fax or e-mail??
E-MAIL       FAX       Both
Phone *Numbers Only
 Fax Numbers Only-if not known, contact Permits Dept
Email *


Cargo Serial Number *15 characters max
 Model / Brand or Make
Load Description / Notes & Comments.... 60 characters max


i.e. 12-3 or 6-9
LOAD WIDTH ft-inch*     		OVERALL WIDTH ft-inch*
LOAD LENGTH ft-inch*   OVERALL LENGTH ft-inch*
LOAD HEIGHT ft-inch*    OVERALL HEIGHT ft-inch*

LOAD & OVERALL WEIGHT LBS*   
TRAILER LENGTH ft-inch*        
OVERHANG FRONT ft-inch*    
OVERHANG REAR ft-inch*       
KINGPIN SETTING ft-inch*       
AXLE SPACINGS ft-inch*
1-2      
2-3      
3-4      
4-5      
5-6      
6-7      
7-8      
8-9      
9-10    
10-11  
11-12  
 WEIGHT PER AXLE *
1  
2  
3  
4  
5  
6  
7  
8  
9  
10
11
12



Origin Address
 City
 State  ex:MN
Destination Address
 City
 State




State Initials Only
STATE
i.e. 14-113-1-95-295..or 295-40-55-EXIT 81A West Market Ave.
ROUTE   55 characters max, if you need more space you will need to call in.
i.e. 12/12..
START DATE






Please ensure that the information on this form is correct and in accordance to your to how the permit should be ordered.