Www.dmv.pa.gov APPLICATION FOR TEMPORARY REGISTRATION ...

MV-351 (7-21)

dmv.

APPLICATION FOR TEMPORARY REGISTRATION PLATES BY MOTOR VEHICLE DEALERS AND FULL AGENTS

For Department Use Only Bureau of Motor Vehicles ? PO Box 68620 ? Harrisburg, PA 17106-8620

PLEASE PRINT LEGIBLY OR TYPEWRITE ALL INFORMATION

Name of Business (as it appears on your registration card/authorization card) Business Address

Indicate number of temporary registration plates desired by class. THE FEE FOR EACH TEMPORARY REGISTRATION PLATE IS $17. (NOTE: PennDOT reserves the right to limit orders of temporary registration plates according to historical use.)

City

State

Zip Code

Product Type

Quantity

Total Cost

o Pick Up Order (Please Include Name and Telephone Information Below)

o Mail Order (Please Included Shipping and Handling Fees)

Dealer/Business Partner/Full Agent ID No.: _________________________

(_______)___________________________________________________

Business Phone Number

Online Registration Participant: o Yes o No

__________________________________________________________

Name of Online Registration Integrator

AUTHORIZATION TO PICK UP REGISTRATION PLATES IN THE BUREAU OF MOTOR VEHICLES.

I/We hereby authorize the following person or Messenger Service:

___________________________________________________________

Messenger/ Driver's License Number: ____________________________________ to pick up this order of registration plates to be delivered to my place of business.

APPLICANT MUST SIGN BELOW. I/We hereby make application for temporary registration plates and certify under penalty of law that ALL information contained herein is TRUE and CORRECT and that I/we understand that any misstatement of fact is a misdemeanor of the third degree punishable by a fine up to $2,500 and/or imprisonment up to 1 year (18 Pa.C.S. Section 4904[b]).

Passenger Plates Truck Plates Trailer Plates Motorcycle Plates Motor Home Plates School Bus Plates Moped Plates Bus Plates Intransit Plates IMP Plates SME Plates Omnibus Plates Permanent Trailer Plates Rear Window Decals * Other

FREE

________________________________________________________

Printed Name of Applicant

Date

________________________________________________________ Applicant Signature

NO RUBBER STAMPS ACCEPTED

IMP = Implement of Husbandry SME = Special Mobile Equipment

TOTAL COST DUE

- Amt. Credit Used

$

+ Shipping and Handling

1 to 50 plates = $7

$

51 plates and up = $12

= Amt. Check Enclosed $

* Must be ordered in multiples of five and should not exceed number of registration plates ordered.

= Cash Provided

$

NOTES:

? DO NOT SEND CASH. ? Make check or money order for mail orders payable to Commonwealth of Pennsylvania. Cash will be accepted in person only. ? Mail signed application along with check or money order to: PennDOT, Bureau of Motor Vehicles, Issuing Agent Registration Center,

P.O. Box 68620, Harrisburg, PA 17106-8620. ? If registration plates are to be picked up at PennDOT, please complete the above authorization.

IMPORTANT: Please check your order to ensure the proper class and the amount of registration plates requested are correct. No exchanges will be made.

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