Form Mvd-376-Permit To Demonstrate A Vehicle Application Form

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Department of

the Secretary of State

Bureau of Motor Vehicles

Patty A. Morneault

Matthew Dunlap

Deputy Secretary of State

Secretary of State

David W. Guilmette

Director, Office of Investigation

& Dealer Licensing

APPLICATION FOR

*PLEASE PRINT CLEARLY*

PERMIT TO DEMONSTRATE

FEE: $1.00

Permission to demonstrate a loaded vehicle is granted to:

Legal Dealership Name: __________________________________________________________________________________

Dealership Physical Address: ______________________________________________________________________________

(Street)

(City/Town)

(Zip)

Dealer Contact Person: ___________________________________ Contact Phone Number: ___________________________

Please note: Valid only for up to seven (7) days, including the date of issuance.

Incomplete applications cannot be processed.

Dealer plate number being used (include suffix): ___________________ Effective Date: _____________ End Date: ____________

Vehicle Year: _____________________________________ Vehicle Make: _______________________________________________

Vehicle Identification Number (VIN): _______________________________________________________________________________

Customer Demonstrating Vehicle: __________________________________________________________________________

Customer’s Address: ____________________________________________________________________________________

(Street)

(City/Town)

(Zip)

Demonstrating will be within a 250 mile radius of: _______________________________________________________________

(Municipality)

This demonstration is to be conducted with not more than the limit of 600 pounds per inch of tire width. This demonstration is legal within the

boundaries of Maine. There is no guarantee that this permit will be accepted in any other jurisdiction. This operation is demonstration only and

is only valid for up to seven (7) days (including the date of issuance).

Please make check or money order payable to the Secretary of State and mail to the Bureau of Motor Vehicles, Dealer

Licensing, 101 Hospital Street, 29 State House Station, Augusta, ME 04333.

Application may be faxed to:

Payment may be made by credit card:

VISA or

MASTERCARD

Dealer Licensing

(207) 624-9126

Credit Card Number: __________________________________________

Expiration Date: ______________________________________________

Dealership Fax Number: _________________

Card Holder’s Name: __________________________________________

Signature

Official Title

Date

MVD-376 Rev 04/2016

101 Hospital Street, #29 State House Station, Augusta, Me 04333-0029 Tel. (207) 624-9000 Ext. 52143 Fax: (207) 624-9126 TTY Users call Maine relay 711