Form 4374 - Application For Registration As A Fleet Vehicle Owner

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MISSOURI DEPARTMENT OF REVENUE
FLEET NUMBER
NEW FLEET
FORM
MOTOR VEHICLE BUREAU
ADD VEHICLES
4374
APPLICATION FOR REGISTRATION
TELEPHONE NUMBER
FAX NUMBER
AS A FLEET VEHICLE OWNER
(REV. 8-2012)
( __ __ __ ) __ __ __ - __ __ __ __
( __ __ __ ) __ __ __ - __ __ __ __
FLEET NAME (LEGAL NAME)
REGISTRATION CYCLE
ANNUAL
BIENNIAL
Registration cycle will be applied to all fleet registration applicable
to fleet company.
CONTACT PERSON
REQUESTING NAME/LOGO ON PLATE
YES
NO
E-MAIL ADDRESS
Companies wishing to display fleet plates with company name or
logo will be required to pay an initial $5.00 per registration. Only
CATEGORY
QUANTITY REQUESTED
fleets with 50 or more vehicles are eligible for logos on their fleet
MAILING ADDRESS
plates.
COMPLETE ALL NUMBERS BELOW THAT APPLY:
US DOT NUMBER
MO DOT NUMBER
FEDERAL EMPLOYEE ID NUMBER
DLN
__ __ __ __ __ __ __
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You must own 10 or more motor vehicles to qualify as a fleet vehicle owner. All motor vehicles must be titled in the exact same name as shown above.
Trailers cannot be registered as fleet vehicles. List below the motor vehicles to be registered in your fleet. (Print/copy this form to attach additional
sheets, if necessary)
CURRENT PLATE
TITLE NUMBER
YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER
NUMBER
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If you are requesting your company logo or name on your fleet plates, you will need to submit an initial $5.00 fleet logo fee at the time of application.
The fees may be submitted in a check payable to the Department of Revenue or by credit card. Complete the following information to have the fees
charged to your credit card. A service fee will apply.
TYPE OF CREDIT CARD
CREDIT CARD NUMBER
EXPIRATION DATE
__ __ / __ __ / __ __ __ __
NAME AS SHOWN ON CREDIT CARD
AUTHORIZED SIGNATURE
DATE
__ __ / __ __ / __ __ __ __
I certify under penalty of perjury that the facts provided herein or in conjunction with this application are true to the best of my knowledge.
SIGNATURE OF OWNER/REPRESENTATIVE
DATE
__ __ / __ __ / __ __ __ __
DOR-4374 (8-2012)

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