DMV REGISTRATION HOLD REQUEST FOR REVIEW FORM

FasTrak? Customer Service Center P.O. Box 26925 | San Francisco, CA 94126 877-BAY-TOLL (877-229-8655) 415-974-6356 (FAX) (+1) 415-486-8655 (Outside the United States)

FOR OFFICE USE ONLY

Date Received Case Number Code

DMV REGISTRATION HOLD REQUEST FOR REVIEW FORM

If there was a hold placed on your DMV vehicle registration due to unpaid toll violations, you may request a review of your dispute by completing this form (use a separate form for each license plate number). Fill in the information requested, print it out, and send it to the address above. To expedite your request, please include a copy of your current DMV registration, DMV registration renewal, and/or documentation of violations already paid directly at the DMV. Within 15 business days from receipt of this form, a letter will be sent to you with the required payment amount due from you, along with a list of all unpaid violations.

IMPORTANT: Submittal of this Request for Review Form will not: 1) release the current hold on your DMV vehicle registration; 2) stop the process of additional violations being sent to DMV Hold and/or Collections; or 3) recall violations which have already been sent to Collections.

REGISTERED VEHICLE OWNER INFORMATION

FIRST NAME*

LAST NAME*

*Required

CURRENT MAILING ADDRESS*

CITY*

STATE*

ZIP CODE*

PHONE NUMBER* (Mobile preferred)

LICENSE PLATE NUMBER*

STATE OF REGISTRATION*

CURRENT FASTRAK ACCOUNT NUMBER (IF ANY)

PREVIOUS FASTRAK ACCOUNT NUMBER (IF ANY)

VIOLATION NUMBER(S) (If more space is needed, attach additional sheets)

WRITTEN DISPUTE (If more space is needed, attach additional sheets)

PRINT NAME FasTrak: DMV Registration Hold Request for Review

SIGNATURE

DATE

VERSION: 11/2023

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download