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M-936A (11-17). OVERSIZE/OVERWEIGHT PREVIOUS. APPLICATION FOR SPECIAL permit NO.: HAULING permit . ''ALL LINES (EXCEPT DASHES) MUST BE COMPLETED" APPLICATION ID: TYPE permit REQUESTED: single trip single trip & Return Annual Seasonal ________months Emergency Preliminary Superload Final Superload _______ of _______. permit OFFICE_________________________________ NAME____________________________________ _____________________________________. REGISTERED NAME (Responsible Motor Carrier). ACCOUNT STREET__________________________________ _____________________________________. MOTOR CARRIER/ permit SERVICE ADDRESS. FEIN/SSN________________________________ ______ CITY-STATE-ZIP CODE____________________________________ _______________________. IF NO MOTOR CARRIER ACCT. NO. 1 = IMMEDIATE PAYMENT. 3 = MONTHLY BILLING. BILL CODE____________________________________ 4 = GOVERNMENTAL CHECK/MO # CHECK/MO #. permit FEE. <. GROSS WEIGHT___________________ (lbs.) LEGAL WEIGHT = __________________(lbs.)

TYPE PERMIT REQUESTED: Single Trip ... Completing PA Permit Application Form M-936A Following are detailed instructions for completing a Permit Application (Form M-936A). All fields underscored with solid lines must be completed. All fields underscored with dashed lines should be completed where applicable if information is known

  Applications, Single, Trip, Permit, Permit application, Single trip