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Form.)
A.) Applicant Information • DO NOT FORGET TO ENTER YOUR SOCIAL SECURITY NUMBER IN THE LIGHT GRAY BOX ABOVE.
Name
LAST
FIRST
Gender
MIDDLE
Birthdate
/
/
Phone (
)
-
Address
STREET ADDRESS
CITY
STATE
ZIP
B.) Plate and/or Placard Information • License plates can only be issued to an applicant whose name appears on the WV vehicle registration.
Request for a Mobility Impaired Plate
Request for a Mobility Impaired Placard
Is this request due to a
Is this request due to...
Show details
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