Indiana > Statewide > Department Of Revenue > Motor Carrier
Application For Authorization CDL IVR System CDL-IVR - Indiana
| Application For Authorization CDL IVR System Form. This is a Indiana form and can be used in Motor Carrier Department Of Revenue Statewide . |
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APPLICATION FOR AUTHORIZATION CDL-IVR SYSTEM 6WDWH )RUP 5 )RUP &'/,95 ,QGLDQD %XUHDX RI 0RWRU 9HKLFOHV Name of Company US DOT Number Address (number and street) City, State, and Z,3 Daytime Telephone Number Contact Person 7KH XQGHUVLJQHG FRPSDQ\ RZQHU RU UHVSRQVLEOH RI¿FHU VXEPLWV WKLV DSSOLFDWLRQ IRU XVH RI WKH ,QWHJUDWHG 9RLFH Response Unit (IVR) system. The purpose of using the IVR is to check the status of a driver's Department of Transportation '27 physical examination form. I also understand that I am making this application with the agreement that an authorization number will be assigned for the sole use of this company to use to check on this company's driver's DOT physicals. Under penalties of perjury, I declare that I have examined this document and to the best of my knowledge and belief, it is true, correct, and complete. 6LJQDWXUH RI 2ZQHU RU 5HVSRQVLEOH 2I¿FHU 'DWH (month day, year) Typed or Printed Name Return this application to: Indiana Bureau of Motor Vehicles 100 N. Senate Ave. N481 Indianapolis, IN 46204 Title American LegalNet, Inc. www.FormsWorkFlow.com
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