- Form VS-113I - Inspection Certificate Order Form - New York
- Form VS-1079DE - Diesel Emissions Inspection Certification - New York
- Form VS-1075 - Inspection Rejection/Advisory Notice - New York
- Form VS-1074M - Vehicle Inspection Record for Motorcycle - New York
- Form VS-120 - Motor Vehicle Inspector Certification Application - New York
- Form VS-121W - Renewal of Certification as a Motor Vehicle Inspector - New York
Fillable Printable Form VS-113I - Inspection Certificate Order Form - New York
Fillable Printable Form VS-113I - Inspection Certificate Order Form - New York
Form VS-113I - Inspection Certificate Order Form - New York
Check the box for the expiration year of the stickers you are ordering. Check only
one.
INSPECTION CERTIFICATE ORDER FORM
PAYMENT
1. Use a separate form for each type of sticker you are ordering.
2. Check the box next to the type of sticker you are ordering.
3. Sign and date this order form.
4. Send a separate check or money order payable to COMMISSIONER OF MOTOR VEHICLES with each order
form. Write your facility number on the check or money order. DO NOT SEND CASH.
5. Optional: If you would like your order returned by express delivery service, add $10.00 to the total cost of your order.
6. Please allow 2-3 weeks for processing and delivery.
7. Send this form and your check or money order to:
Enter the number of books you are ordering and the amount owed:
A $35.00 FEE WILL BE CHARGED FOR ALL RETURNED CHECKS!
Facility Number
Facility Name
Address
City
State
Zip Code
(Authorized Signature)
(Print Name)
(Business Phone)
VS-113I (10/15)
(E-Mail Address)
(Date)
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EXPIRATION YEAR (check one)
Expiration Year 2016 (
RED)
(To be issued in 2015)
Expiration Year 2017 (
BLUE)
(To be issued in 2016)
OR
(Quantity)
___________________book(s) @ $_______________ each
For return express delivery of stickers, add $10.00
TOTAL PAYMENT AMOUNT
= $ ____________________
= $ ____________________
= $ ____________________
You can also order stickers on the DMV web site at www.dmv.ny.gov/sticker
Express Mail
Vehicle Safety Services
6 Empire State Plaza
Room 220
Albany NY 12228
Regular Mail
Bureau of Consumer & Facility Services
PO Box 2700
Albany NY 12220-0700
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Check the box for the type of sticker you need. Check only one.
TYPE OF STICKER (check one)
Safety Only (new vehicles or trailers)
Motorcycle
Heavy duty
Safety/Diesel Emission
Low Enhanced Emissions
$120.00 per book:
$80.00 per book:
OR
o
o
o
o
o
INSTRUCTIONS
FACILITY INFORMATION
reset/clear
