INSTRUCTIONS: ARKANSAS LPG FLAT FEE APPLICATION

When a motor vehicle is converted to be operable on Liquefied Gas Special Fuel, the LPG flat fee application should be submitted within ten days. This document can be obtained from the website maintained by the Arizona Department of Finance and Administration.

Arkansas LPG Flat Fee Application Step 1: Enter the applicant's name in the first box.

Arkansas LPG Flat Fee Application Step 2: Enter the applicant's federal employer identification number or Social Security number in the second box.

Arkansas LPG Flat Fee Application Step 3: Enter the applicant's mailing street address in the third box.

Arkansas LPG Flat Fee Application Step 4: Enter the applicant's telephone number in the fourth box.

Arkansas LPG Flat Fee Application Step 5: Enter the applicant's city, state and zip code in the fifth box.

Arkansas LPG Flat Fee Application Step 6: Enter the vehicle ID number in the sixth box, its make in the seventh box, its year in the eighth box, and its model in the ninth box.

Arkansas LPG Flat Fee Application Step 7: In the tenth box, indicate with a check mark whether the vehicle was purchased used. If so, enter the date the vehicle was tagged in your name in the eleventh box.

Arkansas LPG Flat Fee Application Step 8: In the twelfth box, indicate with a check mark whether the vehicle was factory converted. If so, give the date by which it was converted in the thirteenth box.

Arkansas LPG Flat Fee Application Step 9: Provide all conversion information requested in the next section.

Arkansas LPG Flat Fee Application Step 10: In the next section, indicate the type of vehicle with a check mark.

Arkansas LPG Flat Fee Application Step 11: The second page contains a permit transfer request. Indicate whether conversion equipment is being transferred from a vehicle with a current permit with a check mark.

Arkansas LPG Flat Fee Application Step 12: Give the account number and decal number from your registration card.

Arkansas LPG Flat Fee Application Step 13: If a carburetion unit is being transferred from another vehicle, provide all information requested about the vehicle.

Arkansas LPG Flat Fee Application Step 14: Enter the name, city and state of the person responsible for the conversion work.

Arkansas LPG Flat Fee Application Step 15: Sign and date the bottom of the second page.