Form Mv-372r - Application For Private Service Bureau License Renewal

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APPLICATION FOR PRIVATE SERVICE BUREAU LICENSE RENEWAL

Your Private Service Bureau license, issued by the Department of Motor Vehicles, expires on June 30. In order to renew your license, you

must answer all of the questions on this application and return the completed application with a check or money order payable to the

Commissioner of Motor Vehicles in the amount of $50.00 (the two-year, NON-REFUNDABLE, renewal fee).

INSTRUCTIONS:

Print or type the information requested in this application.

Include a photocopy of the owner’s or employee’s valid New York State driver license or non-driver ID card.

Include a photocopy of the Workers’ Compensation exemption form, or proof of disability insurance.

Include a photocopy of the receipt that you give to your customers.

Name of Private Service Bureau as approved by DMV

PSB License No.

Date of Application (Month/Day/Year)

Mailing Address of Private Service Bureau (No. and Street)

City

State

Zip Code

Telephone No.

Fax No.

Type of Business (check one of the following):

(

)

(

)

Sole Proprietor

Partnership

Corporation

Association

E-mail Address

Other, specify

ANSWER QUESTIONS #1-#7 below.

Yes

¨ ¨

1. Has there been a change in the name of the business since the current license was issued?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If YES, provide the former name of the business and the reason for the business name change. List all URLs/Websites and social

media sites associated with this business. Please note that no changes or additions will be allowed without prior approval by the DMV.

Yes

¨ ¨

2. If your business is a partnership, has any partner changed since the current license was issued? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If YES, provide the names of the previous and current partners and reason(s) for each change.

Yes

¨ ¨

3. Have you changed your business address or the address of any branch office since your current license was issued? . . . . . . . . . . . . .

If YES, provide the previous address(es) and the reason(s) for the change.

Yes

¨ ¨

4. Have you discontinued your business or closed any branch office since your current license was issued? . . . . . . . . . . . . . . . . . . . . . .

If YES, provide an explanation for discontinuing your business or closing any branch office of your business.

If YES, was the license certificate surrendered to the Department of Motor Vehicles?

YES

Yes

¨ ¨

5. Do you have employees who are not volunteers? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If YES, are these employees paid?

YES

If you have employees, attach a photocopy of your valid NYS driver license or non-driver ID card and attach a photocopy of

the valid NYS driver license or non-driver ID card for every employee, along with a copy of your CURRENT disability

insurance policy.

If you do not have employees, attach a photocopy of your valid NYS driver license or non-driver ID card and a CURRENT,

completed copy of the Workers’ Compensation exemption form. You can obtain this form at your local Workers’ Compensation

office or online at This form states that you have NO employees. You do not have to have employees in New

York State in order to conduct business in New York State. The Workers’ Compensation exemption form must be updated every

time you renew your PSB license.

6. At which DMV office or processing center is your paperwork processed? _______________________________________________

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