Louisiana Irp Application Form – Fill Out and Use This PDF

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□ Original

□ Private Carrier(PC)

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□ Renewal

□ Haul for Hire (HH)

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□ Add Fleet

□ Rental Company(RC)

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□ Add Jurisdiction

□ Household Goods

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□ Add/Delete Vehicle

Mover(HC)

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□ Exempt Commodities

□ Change Information

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□ Reinstatement

□ Check this box if this

carrier has intrastate

□ Fleet to Fleet

Authority in Wyoming.

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Fleet_____.

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□ Are you an Owner Operator leased on to a motor carrier?

□ Yes □ No

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Units listed will be authorized to operate in the jurisdictions and at the weights listed on the following page(s).

Weights will be printed on the cab cards for all units

listed on the following page(s).

Vehicles are grouped according to weight on separate pages.

Use separate page for each weight group

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I hereby declare knowledge of the Federal Motor Carrier Safety Regulations (49 CFR parts 383+383, 385+387, and 390+399) and if applicable, including highway related portions of the Federal Hazardous

Materials Regulations (49 CFR parts 100+185) or compatible state rules, regulations, standard and orders applicable to Motor Carrier Safety, including highway transportation of hazardous materials. The undersigned,

under oath swears under penalty of perjury that the information furnished in this application and the attached schedules are true and correct, and that liability security required by law will be maintained on all vehicles

listed on this application.

Signature

Print Name

Date

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Application Received:

Reviewed by:

Keyed by:

NUMBER OF REG MONTHS

Invoice Verified by:

Credentials Mailed by:

Office Location:

Date:

Date:

Date:

Date: