Vehicle Registration Application Form

Vehicle Registration Application and Services Agreement

Applicant Name:    Registration Agent / Office Name:

WHEREAS

WHEREAS, Applicant desires to register the motor vehicle described herein and obtain all necessary certificates, plates, and documentation required by applicable law; and

WHEREAS, Agent agrees to provide registration processing services on behalf of Applicant subject to the terms and payment provisions of this Agreement; and

WHEREAS, Applicant certifies that all information provided in this application is true, complete, and accurate to the best of Applicant's knowledge and acknowledges the legal consequences of false statements.

Applicant Information

Vehicle Information

VIN:    Year:

Make:    Model:

Body Type:    Color:

Registration Details

Registration Action: New Renewal Transfer

Plate Type Requested: Standard Personalized    Desired Plate Combination (if personalized):

Scope of Work

Agent shall prepare, submit and track the registration application and related documentation, procure license plates and registration certificates when authorized by Applicant, assist with lien recordings and provide notarization services if required. Agent's responsibilities expressly include verifying title documentation, calculating applicable fees, and delivering completed registration materials to Applicant. Agent is not responsible for governmental delays beyond its control.

Payment Terms

Registration Fee Amount: $    Agent Service Fee: $

Payment Schedule: Applicant shall pay all governmental fees at time of submission. Agent's service fee is payable upon execution of this application unless otherwise agreed in writing.

Late Payment: Any unpaid sum shall bear a late fee of and collection costs incurred by Agent.

Term and Termination

Term begins on and terminates on completion of the registration services or on , whichever occurs first.

Either party may terminate this Agreement for convenience upon days' written notice to the other; termination does not relieve Applicant of liability for fees earned prior to termination.

Confidentiality

Each party shall maintain the confidentiality of nonpublic personal and business information disclosed in connection with this application. Agent may disclose confidential information only as required by law or to perform registration services (including to governmental authorities). Confidential information does not include information already lawfully in the public domain.

Governing Law; Compliance

This Agreement and the interpretation of this Application shall be governed by the laws of the jurisdiction in which the registration is submitted. Applicant shall comply with all applicable statutes and regulations and shall promptly provide documents reasonably requested by Agent to effect registration.

Certification and Authorization

Applicant certifies under penalty of perjury that the information provided in this Application is true and complete. Applicant authorizes Agent to submit this application, sign ministerial documents on Applicant's behalf when specifically authorized in writing, remit fees, and obtain registration materials. Applicant acknowledges that false statements may subject Applicant to civil or criminal penalties.

Entire Agreement

This document, together with any attachments and the submitted registration documents, constitutes the entire agreement between Applicant and Agent concerning the services described herein and supersedes all prior agreements and understandings, whether written or oral.

Acknowledgment

Applicant affirms that all required documents (title, bill of sale, proof of insurance, emissions certificate if required) are attached or will be provided prior to submission. Applicant understands Agent does not guarantee approval of any governmental application.

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