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* 1. I understand that Puget Sound Clean Air Agency is reimbursing truck owners $60 for their time to watch the clean diesel truck training videos and pass this online test.

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* 2. I would like to apply for the $60 reimbursement that the Puget Sound Clean Air Agency is offering to drayage truck owners who complete this clean diesel truck training and pass this online test. (I understand that the $60 reimbursement will be in the form of a check.)

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* 3. I understand that to qualify for the $60 I must:
- Watch the clean diesel truck training videos
- Own a drayage truck that operates at a Northwest Seaport Alliance terminal (Seattle or Tacoma), and
- Pass this online test.

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* 4. I understand that the Puget Sound Clean Air Agency has the sole authority to decide if I qualify for the reimbursement.

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* 5. I understand that to receive the check, I must provide the following information:

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* 6. I have watched the clean diesel truck training videos. 

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* 7. How did you find out about the Clean Diesel Truck Training?

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