Fillable Printable Form PSB-3 - Name Selection for Private Service Bureau Applicants - New York

Form PSB-3 - Name Selection for Private Service Bureau Applicants - New York

The New York State Department of Motor Vehicles (DMV) must pre-approve the name that you select for

your private service bureau (PSB)

BEFORE you submit an “Application for a License to Operate a Private

Service Bureau or Open a Branch Office” (form MV-372).

Please enter up to three names that you would like DMV to consider, then fax this form to (518) 474-7369

for approval PRIOR to the submission of your application. If a fax machine is not available, please call (518)

473-9947 for assistance. You will be notified of which name has been approved.

NOTE: To avoid public confusion, DMV will NOT approve a name that contains “DMV” or “Motor Vehicle”.

** INCOMPLETE APPLICATIONS WILL RESULT IN THE REJECTION OF YOUR APPLICATION **

NAME SELECTION FORM FOR

PRIVATE SERVICE BUREAU (PSB) APPLICANTS

PSB-3 (10/15)

Name: ______________________________________________________________________________

Phone Number:

( )

area code

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

Name Selection Requests

Requester’s Information

reset/clear