Form Mv-511b - Requisition For Motor Vehicle Forms
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1Date: _______________
MV-511B (7-17)
For Department Use Only
reQUisiTiOn FOr MOTOr veHicle FOrMs
Bureau of Motor Vehicles • 1101 South Front Street • Harrisburg, PA 17104
www dmv pa gov
1. List quantity for each form/pub needed. Please assess your form needs carefully. Over ordering results in increased costs to the commonwealth.
2. to obtain Forms MV-1, MV-4St & MV-120, authorized agents are required to place their DIN/agent Number, authorized agents notary stamp and
signature or verification information in the space provided on this form. (nOTe: Verification information is only valid for 85-86-87 DIN numbers that also
issue temporary registration plates. all other authorized agents must place a notary stamp and signature where indicated.) an aUTHOriZed agenT
is an agenT Under cOnTracT WiTH PenndOT. To obtain Form Mv-355, dealers are required to list their din number.
3. Print or type name and address to which forms are to be mailed in the space provided. Be certain that the address is clear and complete.
nOTe: You must have a street address. P.O. Box only addresses are not accepted.
MOTOr veHicle FOrMs
FOrM
UniT OF
FOrM TiTle
QUanTiTY
nO.
issUe
PaCK (200)
application for Certificate of title
MV-1
2 Pack limit
(Only an authorized agent May Obtain)
PaCK (200)
Vehicle Sales and Use tax Return/application for Registration
MV-4St
2 Pack limit
(Only an authorized agent May Obtain)
PaCK (200)
temporary Registration Plate or temporary Registration transfer
MV-120
2 Pack limit
Card (Only an authorized agent May Obtain)
PaCK (200)
MV-355
Dealer Registration Permit
2 Pack limit
Total Packs of Forms Ordered
nOTe: Orders for Forms MV-1, MV-4St, and MV-120 will not
sHiPPing and Handling Fee inFOrMaTiOn
be filled without DIN/agent Number, authorized agents
notary stamp and signature or verification information.
Shipping and handling fees are required. Fees are calculated per pack of
forms ordered and mailed. If the order will be carried through and picked
nOTe: Orders for Form MV-355 will not be filled without DIN
up by a messenger service, no shipping and handling fee is due.
Number.
Up to 2 total packs ordered = $ 5
Place nOTarY sTaMP Here
3 to 4 total packs ordered = $10
5 or more total packs ordered = $15
Please be sure to include the shipping and handling fee with your
request. if no fee is included, your request will not be filled.
Mailing address and agenT veriFicaTiOn inFOrMaTiOn
DIN/aGeNt NUMBeR
teLePHONe NUMBeR
BUSINeSS NaMe
aDDReSS
Total Packs Ordered
aDDReSS
$
amt. of check enclosed
CItY
State
ZIP
SIGNatURe
PRINteD NaMe
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