Mileage Request

 

This form should be completed if you have FROM mileage that you could not enter into the portal, and only if said mileage causes you to cross over into another rate band, i.e.

 

51+

101+

151+

201+

251+ (requires VMO form instead)

 

NOTE:  Mileage will be verified and must be accurate.  Please double check all mileage before entering