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Toll Tag Form
Toll Tag – RFID
Name
(Required)
First
Last
Bentwater Property Address
(Required)
Email
(Required)
Phone
(Required)
Pick One Option
(Required)
Property Owner
Renter / Leasing
POA Staff
BWCC Staff
Type of Toll Tag
(Required)
Transcore – Ego Tag (from the POA office) (131)
EZ_Tag – HCTR (1)
Texas Tag – TEX (2)
Dallas NTTA- DNT specific (2)
Dallas NTTA – DFW specific (15)
NTTA – non-specific (2)
OTA – Oklahoma Turnpike (3)
KTA – Kansas Turnpike (4)
OTHER – Submit Image (15)
Toll Tag Number
(Required)
Make
(Required)
Model
(Required)
Color
(Required)
Year
(Required)
License Plate
(Required)
State
(Required)
PROOF OF LIABILITY INSURANCE – Is Required:
(Required)
I am uploading the document using the link below
I will email the document to
[email protected]
I understand that the toll tag will not added to the system until the proof of insurance is received.
Upload your insurance document
Max. file size: 1 MB.
Consent Agreement
(Required)
I agree to the statement below.
I understand that I am personally responsible for the above-mentioned vehicle and I attest that this vehicle does belong to my family. I agree to obey all Bentwater traffic regulations. This RFID entrance is issued as a privilege, not an obligation and may be revoked or denied when / if deemed necessary by the Bentwater Property Owners Association. If an outstanding balance exists on your Bentwater POA account, your RFID entrance, may be revoked or denied by the Bentwater Board of Directors.
Replacement Vehicle
(Required)
This is a replacement vehicle.
This is not a replacement vehicle.
If this is a replacement vehicle, please fill out the next 4 items. If it is not, you can scroll to the bottom to submit the form.
Vehicle Information To Remove: Make – Model – Year – Color
please seperate the items with a dash (-)
State
License Plate #
Toll Tag Information
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