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OREGON WEIGHT-MILE TAX ENROLLMENT APPLICATION CONTINUATION SHEET FORM 735-9076A (3-20) OREGON DEPARTMENT OF TRANSPORTATION COMMERCE AND COMPLIANCE DIVISION 3930 FAIRVIEW INDUSTRIAL DRIVE SE SALEM OR 97302-1166 PH (503) 378-6699 FAX (503) 378-6880 ACCOUNT NUMBER SUB BUSINESS NAME EFFECTIVE DATE OWNED LEASED SOLO AXL COMB #4 AXL COMB #3 AXL COMB #2 AXL COMB #1 AXL HUB KM REASON FOR APPLICATION ADD VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED) BASE LICENSE NO LESSOR ODO READING ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT FEE BASIS BD RE-ENROLL VEHICLE CANCEL VEHICLE OWNED LEASED SOLO AXL COMB #4 AXL COMB #3 AXL COMB #2 AXL COMB #1 AXL HUB KM REASON FOR APPLICATION ADD VEHICLE RE-ENROLL VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED) BASE LICENSE NO LESSOR ODO READING ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT FEE BASIS BD CANCEL VEHICLE OWNED LEASED SOLO AXL COMB #4 AXL COMB #3 AXL COMB #2 AXL COMB #1 AXL HUB KM REASON FOR APPLICATION ADD VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED) BASE LICENSE NO LESSOR ODO READING ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT FEE BASIS BD RE-ENROLL VEHICLE CANCEL VEHICLE OWNED LEASED SOLO AXL COMB #4 AXL COMB #3 AXL COMB #2 AXL COMB #1 AXL HUB KM REASON FOR APPLICATION ADD VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED) BASE LICENSE NO LESSOR ODO READING ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT FEE BASIS BD RE-ENROLL VEHICLE CANCEL VEHICLE OWNED LEASED SOLO AXL COMB #4 AXL COMB #3 AXL COMB #2 AXL COMB #1 AXL HUB KM REASON FOR APPLICATION ADD VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED) BASE LICENSE NO LESSOR ODO READING ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT FEE BASIS BD RE-ENROLL VEHICLE CANCEL VEHICLE OWNED LEASED SOLO AXL COMB #4 AXL COMB #3 AXL COMB #2 AXL COMB #1 AXL HUB KM REASON FOR APPLICATION ADD VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED) BASE LICENSE NO LESSOR ODO READING ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT FEE BASIS BD RE-ENROLL VEHICLE CANCEL VEHICLE
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