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We or I, owner of request to establish an escrow account for the specific
purchase of oversize and/or overweight load permits from the Texas Department of
Transportation.
Set Up Account
Upon receipt of initial minimum deposit of $305.00, an escrow account will be
established and account number will be assigned.
Base Charge
The initial and all other deposits require an administrative fee of $5.00
per deposit to cover expenses associated with the management of each
account.
Account Notification
The department will provide an account statement per deposit. Replenish the
escrow account by submitting a check, cashier’s check, or money order payable to
the department in the amount of $305.00. Permits will not be issued if an
insufficient balance exists.
This agreement is entered into under the provisions of House Bill 1895,
passed by the 73rd Texas Legislature.
(Company Name) /Contact Person:
Phone Number:
Address:
Signature of Owner:
ICC/Motor Carrier Registration Number:
TxDOT Use Only
Approved Date
Account No. Assigned
Please retain a copy of this agreement for your records.
Please return this request if there is a termination of business
Cancellation Request (Please Print)
I, owner of:
request cancellation of Account No. ______________________ and request a
refund of the unused portion of the escrow account.
Signature:
Signature Date: |
