PERBA
Louisiana Department of Transportation and Development
P.O. Box 94042
Baton Rouge, Louisiana 70804-9042
Attention: Truck Permits Section
Fax Number: 225-377-7108
Application for:
Escort Vehicle Permit&&&&Out of state $10.00 per vehicle&&&&No fee for in state
Please enclose a check, money order, credit card information below or DOTD charge account number 

Customer Information
Issued to Customer Number: Paid by Customer Number::
EFFECTIVE DATE FOR PERMIT:
Company Name:
Address:
City, State & Zip
Phone Number:


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Company name:
Address:
City, State & Zip
Phone Number:


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Click here if address is same --> Copy
Fax Number: Email Address:
 
Complete name and address if mailed to other than above:
 

Vehicle Information
MakeVINTruck LicenseLicense State
Payment Info (if applicable):
 
Payment type: Visa MasterCard American Express Charge to Account
 
Card Number: Expiration Date:
Name on Credit Card: Phone # of Cardholder:
Card Verification Value(CVV2): (CVV2 is the 3-digit number found on the the back of your card/ On AMEX cards, it is 4 digit on the front of the card)
 

Contact Person: Date:07/25/2014

 


*******************************THIS IS NOT A PERMIT****************************



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