Form 5261 - Request For Fleet Plates With Company Name Or Logo Design

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MISSOURI DEPARTMENT OF REVENUE
MOTOR VEHICLE BUREAU
FLEET REGISTRATION
FORM
PO BOX 2076, JEFFERSON CITY MO 65101-2076
5261
(573) 751-0426
REQUEST FOR FLEET PLATES WITH COMPANY NAME OR LOGO DESIGN
(REV. 3-2013)
This form needs to be completed when requesting a fleet plate containing your company’s name/logo.
Only fleets with 50 or more vehicles are eligible for logos on their fleet plates. Please complete this request
for Fleet Logo Plates and mail it to the address above. Please allow 3-5 weeks for new plates to arrive.
FLEET OWNER NAME:
DATE:
__ __ /__ __ /__ __ __ __
CONTACT NAME:
FLEET NUMBER:
CONTACT’S PHONE NUMBER:
( __ __ __ ) __ __ __ - __ __ __ __
CONTACT’S E-MAIL ADDRESS:
CONTACT’S FAX NUMBER:
( __ __ __ ) __ __ __ - __ __ __ __
Indicate the number of plates needed in each category. Requires a $5.00 charge per vehicle.
Passenger
Bus
Motorcycle
Land Improvement
__________
__________
__________
__________
6,000
12,000
18,000
24,000
26,000
___________
__________
__________
__________
__________
30,000
36,000
42,000
48,000
54,000
__________
__________
__________
__________
__________
60,000
66,000
73,000
78,000
80,000
__________
__________
__________
__________
__________
PAYMENT METHOD
Check (enclosed)
Credit Card (provide credit card information below)
AUTHORIZATION
Name as Shown on Credit Card _________________________________
Type of Credit Card_____________________
Credit Card Number __________________________________________
Credit Card Expiration Date ______________
The authorized signatory acknowledges by signing this request that upon registration or renewal of registration, all
motor vehicles in the fleet will be issued a fleet logo plate. The signatory further authorizes any credit card payment
as may be indicated in this request.
Authorized Signature __________________________ Printed Name ________________________ Date ___________
A service fee will apply when using a credit card.
Upon completion, this form will be returned to you with a tracking number and the plate number(s) ordered.
Submit the following documents when registering the
vehicle(s) through the Central Office:
If you wish to obtain your logo plates from a
1. Application for Title and or License (DOR-108);
License Office, indicate which office here:
2. Assigned title or Certificate of Origin;
3. Safety/Emissions Inspection if applicable;
______________________________________
4. Personal Property Tax Receipt;
5. Proof of Insurance; and
6. Appropriate fees.
Department of Revenue Use Only:
________________________________________________________________
Tracking Number
__________________________________________________________
Plate Number(s) Ordered
__________________________
Date Plate(s) Ordered
DOR-5261 (3-2013)

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