State Line Pilot Car 
& Permit Service, LLC
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Returning customer?  Your order is complete. Thank you. 

New customer? Please continue to complete registration so your order can be processed.

Please fill out the client registration form. We require a credit card on file for all new customers, however, you may contact the office to arrange other payments methods if preferred


These Forms can also be emailed or faxed to you upon request.
Office phone (585) 394-9364
Email  Permits@Statelinepilotcar.com

Permits
New client registration form

State Line Pilot Car & Permit Service, LLC

4052 Stoddard Rd

Canandaigua, NY 14424

Office: 585-394-9364      Fax: 585-393-4332

E-mail: Permits@Statelinepilotcar.com

company name: *
Contact person: *
Billing Address: *
 City: *  
 State: *  
 Zipcode: *  
DOT #: *
FEIN #: *
Phone #: *
Email: *
Fax #: *
Credit Card Authorization Information

Name as it appears on card: *
 Card type
 Master CardVisaAmerican Express
 Card Number: *  
 Expiration Date: *  
 Three Digit CVV/CVC code: *  
 Todays Date: *  
 You agree that all the above information is true and give State line Pilot car
permission to apply charges
to above mentioned credit card
Agree