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Complete this form in order to establish an account with the State of Connecticut. This account may be used to submit applications electronically for commercial vehicle credentials.
* Indicates a required field
(min 8 chars)
(min 8 chars)
(min 8 chars)
*
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USDOT Number
IRP Account Number
CT-based Interstate Carriers Only
IFTA Account Number
CT-based Interstate Carriers Only
Tax Reg. Number -
Business Address
( ) -
Fax ( ) -
Check here if your Mailing Address is the same.
Mailing Address
Street Address 1
Street Address 2
City
State/Province
Check here if your Contact Address is the same.
Contact Address
Street Address 1
Street Address 2
City
State/Province
/
Phone ( ) -
Fax ( ) -
60 State Street Wethersfield, CT 06161 / Phone: 860-263-5700
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