In the realm of motor carrier operations within Indiana, the process of handling payments for various services and applications has been streamlined through the use of the Indiana Department of Revenue MC-CCP State Form 51694. Designed specifically for Motor Carrier Services Division applications, this Credit Card Payment Authorization Form facilitates an efficient transaction process for those seeking to use a credit card to settle fees. As a document ready to accommodate an array of applications—be it BAS-2, IFTA-101, or others—it demands careful completion and submission alongside the necessary application paperwork to distinct sections as required, highlighting the imperative to not amalgamate payments across different sections. The form captures essential details ranging from the legal and doing business as (DBA) names of the entity applying, the credit card holder's information, to specific identification numbers that include DOT, FHWA/MC, TID, FEIN/SSN, among others, underscoring the comprehensive nature of this authorization form. Detailing both Visa and MasterCard as acceptable credit card types, it not only simplifies the payment process but also insists on the signer's acknowledgment for the amounts charged, thereby embodying a significant step in the processing of motor carrier service applications in Indiana.
| Question | Answer |
|---|---|
| Form Name | Mc Ccp State Form 51694 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | SSN, DBA, IFTA-101, Indiana |
Indiana Department of Revenue
State Form 51694
Credit Card Payment
Authorization Form
For Motor Carrier Services Division
Use this form anytime you want to use a credit card to pay a fee for a Motor Carrier Services Division application.
Fax this Authorization form in with your Motor Carrier Services application(s) (i.e.,
Legal Name:
D/B/A Name:
Name on Credit Card: |
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Address: |
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City: |
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State: |
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Zip Code: |
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Telephone Number: |
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DOT# |
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FHWA/MC# |
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TID# |
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FEIN/SSN |
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IRP Acct# |
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FLT# |
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TRANS #’S |
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REG YEAR |
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OSOW Company# |
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MasterCard
Visa
Account Number__ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Expiration Date______/_______ |
Amount $__________________ |
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Month |
Year |
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Cardholder Signature ____________________________________________________
Instructions for
for Motor Carrier Services Division
Note: This form is used if you choose to pay your fees using your Visa or Mastercard.
Legal Name: If you are a sole proprietor this will be your name. If you are a partnership enter the legal partnership name. If you are a corporation enter the corporation name.
DBA Name: If your business entity is operating under a name other than your legal name, enter that name here. Otherwise enter “N/A” if this does not apply.
Name on Credit Card: Enter the name that appears on the credit card.
Address: Enter the complete mailing address of the credit card.
Telephone Number: Enter the telephone number, including the area code, of the principal place of business.
DOT #: Enter your US DOT number or Indiana ID number assigned to your motor carrier operation by either the U.S. Department of Transportation or the Indiana Department of Revenue. Otherwise enter “N/A” if your are a new applicant.
FHWA/MC#: Enter the motor carrier “FHWA” or “MC” number under which the Federal Highway Administration (FHWA) issued your operating authority, if applicable. Otherwise enter “N/A” if this does not apply. Interstate Carriers who are for hire and are operating in the Chicago or Louisville Commercial Zones must enter “CCZ” or “LCZ” on this line.
TID#: This is the Taxpayer Identification Number issued by the Indiana Department of Revenue. Otherwise enter “N/A” if you are a new applicant.
FEIN/SSN: This is the Federal Employer Identification Number for corporations, partnerships, and LLC’s. Enter your social security number if you are a sole proprietor.
IRPAcct#: This is your IRP (International Registration Plan) number issued by the Indiana Department of Revenue. Otherwise enter “N/A” if you are a new applicant or this does not apply.
FLT#: This is the fleet number for your IRP account number. Otherwise enter “N/A” if you are a new applicant or this does not apply.
Trans #’s: This is your transaction number for your IRP renewal. This can be found on your preprinted IRP renewal. Otherwise enter “N/A” if your are a new applicant or this does not apply.
Reg. Year: This is the calendar year that you are remitting fees. Otherwise enter “N/A” if you are a new applicant or this does not apply.
OS/OW Company #: This is the OS/OW number that you use to obtain your permits. Otherwise enter “N/A” if you are a new applicant or this does not apply.
Master Card or Visa: Mark the box that applies for the type of charge card you are using.
Account Number: This is your account number for the credit card you are using.
Expiration Date: Enter the expiration date for the credit card that you are using.
Amount: Enter the amount that you are authorizing the Department of Revenue to charge to your account for fees due.
Credit Card Holders Signature: The person that the credit card belongs to must sign the form in order to authorize the Department to charge fees to that account.
To expedite your service, please be sure to fax your paperwork along with the credit card authorization form to the correct section. The fax numbers per section are listed below.
Fax Numbers
US DOT & SSRS (317)
MCFT & IFTA (317)
IRP (317)
OS/OW (317)