Individual Vehicle Mileage Report (IVMR)

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X or mail completed forms to Blue Ridge North America LLC on a weekly or by-weekly basis. Thank You and HAVE A SAFE TRIP Mileage Information Fuel Information DATE STARTING ODOMETER STATE ENDING ODOMETER HIGHWAYS USED GALLONS AMOUNT CITY STATE dyed diesel All information stated above is accurate and true. Driver Signature Please mail completed forms to Blue Ridge North America LLC. PO 279 Box Bogart, GA 30622 or Fax to (770)868-1066 or (800)971-1783 Phone (678)425-9571.

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