420-B11-013 Mark Designation and Signature Page

Mark Signature Page
Tractors & Trailers
EPA’s SmartWay Transport® Partnership is an innovative program that recognizes Partners for setting and achieving
greenhouse gas (GHG) reduction goals in freight transport.
By signing this agreement,
Company or Organization Name

signifies that it has read and will comply with

the SmartWay® Graphic Standard and Usage Guide. I further certify that my organization has or plans to purchase:

number(s) of U.S. EPA Designated SmartWay Tractors
number(s) of U.S. EPA Designated SmartWay Trailers

as part of my fleet. I also commit to maintain the SmartWay Tractors and SmartWay Trailers per the manufacturer’s recommendations or replace them as necessary.

Indicate needed logo:
Briefly state the SmartWay logo
dimensions and placement on
fleet vehicles.

q SmartWay Tractor

q SmartWay Trailer

SmartWay Tractor Logo Dimensions: 
SmartWay Tractor Logo Placement: 
SmartWay Trailer Logo Dimensions: 
SmartWay Trailer Logo Placement: 

Authorized Partner Official:
The undersigned, on behalf of
, understands and agrees to the terms of
the U.S. EPA SmartWay Graphic Standards and Usage Guide for use of the applicable SmartWay logo(s).
Signature:

Title: 

Print name:

Date: 

Key Partner/Organization Contact for SmartWay: (may be different from above individual)
Name: 
Title: 
Address: 
City:

State:

Zip: 

E-mail:

Phone:

Fax: 

OMB No: 2060-0663
Expiration Date: XX/XX/2017
Burden Statement: Public reporting burden for this collection of information is estimates that it take to take a maximum of 2.75 hours to compile and
submit the SmartWay Equipment Checklist and Mark Signature Form. This is a one-time submittal.

U.S. EPA Office of Transportation & Air Quality • [email protected] • (734) 214-4767 phone • (734) 214-4052 fax • www.epa.gov/smartway