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Fillable Printable Form MV-931 - Secure Power of Attorney Order Form - New York

Fillable Printable Form MV-931 - Secure Power of Attorney Order Form - New York

Form MV-931 - Secure Power of Attorney Order Form - New York

Form MV-931 - Secure Power of Attorney Order Form - New York

MV-93.1 (2/15)
SECURE POWER OF ATTORNEY
(MV-93) ORDER FORM
www.dmv.ny.gov
FACILITY INFORMATION
ORDER INFORMATION
AUTHORIZATION
To order a supply of Secure Power of Attorney forms (MV-93):
1. Complete each section of this form. Be sure to sign and date the Authorization section.
2. Enclose a check or money order payable to
COMMISSIONER OF MOTOR VEHICLES. DO NOT SEND CASH.
3. Write your facility number on your check or money order.
4. Optional: If you would like your order shipped by express delivery service, please add $10.00 to
the total cost of your order.
5. Send this form to DMV:
______________ packages @ $125.00 each = $ ________________________
Optional express delivery of order (add $10.00) =$ ________________________
TOTAL PAYMENT AMOUNT =$ ________________________
A $35.00 FEE WILL BE CHARGED FOR ALL RETURNED CHECKS!
Facility NumberFacility Name
Address City Zip Code
Date
Authorized Signature
Print Name
E-mail Address
Business Phone
(Quantity)
BY REGULAR MAIL
Bureau of Consumer & Facility Services
PO Box 2700
Albany NY 12220-0700
BY EXPRESS DELIVERY
Vehicle Safety Services
6 Empire State Plaza, Room 220
Albany NY 12228
Secure Power of Attorney forms (MV-93) are available in packages of 25 forms and cost $125.00 for
each package.
INSTRUCTIONS FOR THIS ORDER FORM
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