Fillable Printable Form VS1-PROV - Provisional Dealer Registration Application - New York

Form VS1-PROV - Provisional Dealer Registration Application - New York

New York State Department of Motor Vehicles

PROVISIONAL DEALER REGISTRATION AND

INSPECTION STATION LICENSE APPLICATION

This form may only be used by New Vehicle Dealers.

Business Name

Business Street Address (physical location) Business Phone No. (Area Code)

( ) -

City

State ZIP County

Print name and location of business, and business e-mail address, below:

Business E-mail Address

I have read Part 78 of the Commissioners Regulations including Section 78.4 pertaining to the Provisional New Motor Vehicle Dealer

Registration that I am applying for and fully understand all responsibilities and requirements (available at

http://dmvweb/comregs/F078.htm#p78-3

). All owners and officers must print, sign and date as your name appears in the VS-1. Attach

additional pages if needed.

I have read Part 79 of the Commissioners Regulations including Section 79.7 pertaining to the Provisional Inspection Station License that

I am applying for and fully understand all responsibilities and requirements (available at http://dmvweb/comregs/F079.htm#p79-7). All

owners and officers must print, sign and date as your name appears in the VS-1. Attach additional pages if needed.

o Check this box if applying for a Provisional New Motor Vehicle Dealer Provisional Registration

o Check this box if applying for a Provisional Inspection Station License

First Name MI

Date

Title

Last Name

SIGN

HERE

First Name

Date

Title

First Name MI

Date

Title

DMV

USE

ONLY

TRACKING #

FACILITY #

Contact Person Last Name

First Name

Phone

( ) -

e-mail address

Title

This form must be attached to a completed VS-1 Original Facility Application with all required documents and payments.

Is or was there previously a

New Vehicle Dealer at this location?

If yes, please give the DMV facility

number and closing date if known:

DMV Facility Number

Closing Date

Provisional items you will receive:

DEALER

INSPECTION STATION

Please include one check for the Business Type(s) applied for:

o Application fee $ 37.50

o Dealer Registration fee $450

o Inspection Station License and Repair Shop Registration fee $250

Please include separate check(s) for each of the following forms:

o $1,260 (5) MV-50 books

o $610 (5) Books of Safety Emission Inspection Certificates

o $410 (5) Books of Safety Inspection Certificates

Once all forms, documents, and checks are received and approved, you will receive a package sent by UPS with the following items and

you may begin to operate only in Provisional status until the Vehicle Safety onsite investigation. If your dealership is approved, the New

Motor Vehicle Dealer and Inspection Station business certificates will be mailed at a later date. If you are denied by a DMV Inspector you

must return all MV-50s and all inspection stickers to Vehicle Safety.

VS-1PROV (6/13)

o Yes o No

Additional dealer plates and or MV-50 books may be requested through your regional office during the onsite investigation.

1. Provisional Inspection Station License Letter

2. Inspection License Bar Code

3. Safety Emission Inspection Certificates (5 books)

4. Safety Inspection Certificates-(5 books)

1. Provisional Dealer Registration Letter

2. Dealer Plate (10 plates) Approval Letter

3. MV-82 form for approved dealer plates

4. MV-50 books (5)

AFFIRMATION:

DMV MUST RECEIVE APPLICATION FEES AND APPLICABLE FORMS FOR:

Last Name

SIGN

HERE

Last Name

SIGN

HERE

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