Transcription of www.dmv.pa.gov APPLICATION FOR TEMPORARY …
1 APPLICANT MUST SIGN BELOW. I/We hereby make APPLICATION for TEMPORARY registration plates andcertify under penalty of law that ALL information contained herein isTRUE and CORRECT and that I/we understand that any misstatementof fact is a misdemeanor of the third degree punishable by a fine up to$2,500 and/or imprisonment up to 1 year (18 Section 4904[b]). _____Printed Name of Applicant Date_____Applicant Signature NO RUBBER STAMPS ACCEPTED For Department Use OnlyBureau of Motor Vehicles PO Box 68620 Harrisburg, PA 17106-8620 PLEASE PRINT LEGIBLY OR TYPEWRITE ALL INFORMATION - Amt. Credit Used $ + Shipping and Handling1 to 50 plates = $7$51 plates and up = $12 = Amt.
2 Check Enclosed $= Cash Provided$Indicate number of TEMPORARY registration plates desired by class. THEFEE FOR EACH TEMPORARY REGISTRATION plate IS $15.(NOTE:PennDOT reserves the right to limit orders of temporaryregistration plates according to historical use.)Dealer/Business Partner/Full AgentIdentification Number: _____Online Registration Participant: oYes oNo_____Name of Business (as it appears on your registration card/authorization card) Business Address CityStateZip Code AUTHORIZATION TO PICK UP REGISTRATION PLATES INTHE 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 placeof business.
3 IMP = Implement of Husbandry SME = Special Mobile Equipment *Must be ordered in multiples of five and should not exceed number of registration plates ordered. IMPORTANT: Please check your order to ensure the proper class and the amount of registration plates requested are correct. No exchanges will be TypeQuantity Total Cost 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 * FREE OtherTOTAL COST DUENOTES: DO NOT SEND CASH. Make check or money order for mail orders payable to Commonwealth of Pennsylvania. Cash will be accepted in person only.
4 Mail signed APPLICATION along with check or money order to: PennDOT, Bureau of Motor Vehicles, Issuing Agent RegistrationCenter, Box 68620, Harrisburg, PA 17106-8620. If registration plates are to be picked up at PennDOT, please complete the above ( )Name of Online Registration IntegratorBusiness Phone NumberMV-351 (11-18) FOR TEMPORARY REGISTRATIONPLATES BY MOTOR vehicle DEALERS ANDFULL AGENTS
