Vehicle Registration Authorization Form

VEHICLE REGISTRATION AUTHORIZATION FORM

RECITALS

WHEREAS, Owner Name: is the legal titleholder of the motor vehicle described below; and

WHEREAS, Owner desires to authorize an agent to act on Owner's behalf for the purpose of applying for, obtaining, renewing, surrendering, or otherwise managing vehicle registration and related administrative tasks; and

WHEREAS, Agent Name: accepts such authorization subject to the terms and limitations set forth in this form.

PARTIES AND CONTACT INFORMATION

Individual Business / Organization

VEHICLE INFORMATION

AUTHORIZED AGENT INFORMATION

SCOPE OF AUTHORIZATION

The Owner hereby authorizes the Agent to act as Owner's lawful agent for the purpose of handling all matters relating to the registration, titling, and administrative management of the vehicle referenced above. The Agent's authority expressly includes:

The Agent is authorized to perform the following acts on behalf of the Owner (select all that apply):

Submit and sign applications for registration and title Receive and collect registration certificates, license plates, and related documents Pay registration, title, or administrative fees on Owner's behalf Surrender or transfer registration or plates as required

PAYMENT TERMS

Registration Fee Amount: $

Who will pay fees:

Payment schedule or method:

Late payment fee (if applicable):

TERM AND TERMINATION

This authorization becomes effective on: and will expire on: unless earlier revoked in writing.

Owner may revoke this authorization by delivering written notice to the Agent. Revocation becomes effective upon receipt by the Agent or upon the effective date of notice specified by the Owner, not to exceed days after delivery.

CONFIDENTIALITY AND DATA USE

Both parties acknowledge that the registration process requires the disclosure of personal identifying information and vehicle records. The Agent shall use such information solely for the purpose of performing the duties authorized herein and shall not disclose Owner's personal information to third parties except as required by law or necessary to effect registration, payment, or transfer. Agent shall take commercially reasonable measures to safeguard personal information in its possession.

REPRESENTATIONS, WARRANTIES AND CERTIFICATION

Owner represents and warrants that Owner is the lawful owner of the vehicle described herein and has full authority to grant the Agent the authorities set forth in this form. Owner certifies that all information provided on this form is true, complete and accurate to the best of Owner's knowledge, and acknowledges that false statements may result in civil or criminal liability.

GOVERNING LAW

This Authorization shall be governed by and construed in accordance with the laws of the State of without regard to principles of conflicts of law.

ENTIRE AGREEMENT

This document constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations and understandings, whether written or oral. Any amendment or modification to this Authorization must be made in writing and signed by both parties.

ACKNOWLEDGMENT

By signing below, Owner appoints the Agent to perform the acts authorized herein and acknowledges receipt of a copy of this Authorization. Agent accepts the appointment and agrees to perform the authorized duties in accordance with applicable law and the terms set forth in this document.

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