Legal Business / Fleet Name *

DBA / Company Name *

Authorized Representative First Name *

Authorized Representative Last Name *

Representative Title *

Email *

Phone *

USDOT Number *

California CA Number *

Address

Street Address

Country

State

City

Postal Code

Enrollment Type *

Select an option

Number of Vehicles Being Enrolled

Enter total number of vehicles

Upload Completed Fleet Vehicle List *

Click to upload

Need the Fleet Vehicle Enrollment Template? Use the template link provided above, enter one vehicle per row, download the completed sheet as XLSX, and upload it here.

VEHICLE INFORMATION

Unit / Fleet Number

Vehicle Year

Vehicle Make

Vehicle Model

VIN

License Plate Number

License Plate State

Current Odometer / Mileage

CARB/Clean Truck Check ID or applicable certificate/vehicle identifier

I certify that I am authorized to submit this enrollment on behalf of the business identified above and that the business, contact, and vehicle information provided is accurate and complete to the best of my knowledge.

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