Application For Tow Truck Decals - State

Application For Tow Truck Decals

INSTRUCTIONS

This application must be submitted at a Motor Vehicle Commission Agency with the following:

1. A standard vehicle registration application or pre-printed renewal notice

2. A valid Certificate of Insurance showing:

a) Minimum liability of $750,000 for light/medium rating. Either a manufacturer¡¯s statement of origin

(MSO) or owner/lease certification on this form.

b) Minimum liability of $1 million for heavy-duty tow trucks. Either a manufacturer¡¯s statement of origin

(MSO) or owner/lease certification on this form.

3. Documentation of manufacturer¡¯s gross vehicle weight rating. Either a manufacturer¡¯s statement of origin (MSO)

or owner/lessee certification on this form

Check One:

Light/Medium Duty (under 32,000 lbs.)

Heavy Duty (32,000 lbs. or more)

Name and address of company (principal business address)

Name _________________________________________________________________________________________________

Street Address __________________________________________________________________________________________

City: ______________________________________________ State __________________________ Zip Code ___________

Business phone number ___________________________ Cell phone number _______________________________________

Name and address of principal owner or owners

Name _________________________________________________________________________________________________

Street Address __________________________________________________________________________________________

City: ______________________________________________ State __________________________ Zip Code ___________

Business phone number ___________________________ Cell phone number _______________________________________

Address of any and all storage lots or garages used

Name _________________________________________________________________________________________________

Street Address __________________________________________________________________________________________

City: ______________________________________________ State __________________________ Zip Code ___________

Address of any and all storage lots or garages used

Name _________________________________________________________________________________________________

Street Address __________________________________________________________________________________________

City: ______________________________________________ State __________________________ Zip Code ___________

I certify that the gross vehicle weight rating is: __________________________

Signature of Owner or Lessee: ______________________________________________________________________________

I certify the statements made by me on this form are true. I am aware if any of the statements are willfully false, I am subject to

administrative, civil, and/or criminal penalty.

BA-49T (R10/18)

FOR MVC USE ONLY

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