Do you have an existing EXpressToll account? Yes No
Name of Primary Account Holder or Applicant
Name of Secondary Account Holder or Applicant
Address
City
State
Zip
Either XXXXX or XXXXX-XXXX for ZIP or ZIP+4
Work Phone
Use xxx-xxx-xxxx for the format of the work phone number.
Home Phone
Use xxx-xxx-xxxx for the format of the home phone number.
Email Address
License Plate Number
Valid license plates contain only alphanumeric characters, periods, spaces, and hyphens and are 7 characters or less in length.
State of Registration
Number of Axles
Vehicle Make Manufacturer
Vehicle Year
Use a four digit year; Examples: 1999, 2004
Vehicle Model
Vehicle ID Number (VIN)
CDOT is not responsible for applications which are lost and/or not received by the Department.

I declare under penalty in the second degree, and any other applicable state or federal laws, that the statements made on this document are true and complete to the best of my knowledge.