Mv-581 (8-08) 72 Hour Trip Reciprocity Permit Application

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MV-581 (8-08)
PA Department of Transportation
72 HOUR TRIP RECIPROCITY
Bureau of Motor Vehicles
Commercial Registration Section
PERMIT APPLICATION
P.O. Box 68286
Harrisburg, PA 17106-8286
FOR DEPARTMENT USE ONLY
PERMIT AGENTS MUST PURCHASE A MINIMUM OF ONE (1) BOOK . EACH BOOK CONTAINS
TWENTY-FIVE (25) SINGLE TRIP PERMITS. EACH BOOK IS VALUED AT $375.00 (25 PERMITS @
$15.00 EACH)
Permit Agent Last Name (or Full Business Name) First Name
Middle Name
Business ID# (i.e. EIN)
Agent Number
Mailing Address
State
Zip Code
City
Number of Permit Books Requested
Total Due
(25 Permits per book)
@375.00 book
$
I hereby certify that the permits applied for will be used in accordance with the statutes and the rules and
regulations of Pennsylvania.
Signature of Permit Agent
Email Address/Telephone Number
Title of Permit Agent
Date
Make check or money order payable to the Commonwealth of Pennsylvania and mail it along with this application to the above
address.
FOR DEPARTMENTAL USE ONLY
(Applicant, Please DO NOT write here)
PERMIT NUMBERS ISSUED ____________________________
Beginning
Ending
DATE ISSUED/MAILED _______________________
REQUEST VERIFIED BY ______________________
Check
Money Order
Cash
VISIT US AT

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