Form Vs-1prov - Provisional Dealer Registration And Inspection Station License Application
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1TRACKING #
DMV
USE
FACILITY #
ONLY
This form must be attached to a completed VS-1 Original Facility Application with all required documents and payments.
Print name and location of business, and business e-mail address, below:
Business E-mail Address
Business Name
Business Street Address (physical location)
Business Phone No. (Area Code)
(
)
-
State
ZIP
County
City
MI
First Name
Contact Person Last Name
Phone
e-mail address
Title
(
)
-
DMV Facility Number
Closing Date
Is or was there previously a
o
o
If yes, please give the DMV facility
New Vehicle Dealer at this location?
Yes
No
number and closing date if known:
DMV MUST RECEIVE APPLICATION FEES AND APPLICABLE FORMS FOR:
Please include one check for the Business Type(s) applied for:
Please include separate check(s) for each of the following forms:
4
o
o
Application fee $ 37.50
$1,260 (5) MV-50 books
4
o
o
Dealer Registration fee $450
$610 (5) Books of Safety Emission Inspection Certificates
o
o
Inspection Station License and Repair Shop Registration fee $250
$410 (5) Books of Safety Inspection Certificates
Once all forms, documents, and checks are received and approved, you will receive a package sent by UPS with the following items and
you may begin to operate only in Provisional status until the Vehicle Safety onsite investigation. If your dealership is approved, the New
Motor Vehicle Dealer and Inspection Station business certificates will be mailed at a later date. If you are denied by a DMV Inspector you
must return all MV-50s and all inspection stickers to Vehicle Safety.
Provisional items you will receive:
DEALER:
INSPECTION STATION
1. Provisional Dealer Registration Letter
1. Provisional Inspection Station License Letter
2. Dealer Plate (10 plates) Approval Letter
2. Inspection License Bar Code
3. MV-82 form for approved dealer plates
3. Safety Emission Inspection Certificates (5 books)
4. MV-50 books (5)
4. Safety Inspection Certificates-(5 books)
Additional dealer plates and or MV-50 books may be requested through your regional office during the onsite investigation.
A F F I R M AT I O N :
o
Check this box if applying for a Provisional New Motor Vehicle Dealer Provisional Registration
o
Check this box if applying for a Provisional Inspection Station License
I have read Part 79 of the Commissioners Regulations including Section 79.7 pertaining to the Provisional Inspection Station License that
I am applying for and fully understand all responsibilities and requirements (available at https://dmv.ny.gov/forms/cr79.pdf). All owners
and officers must print, sign and date as your name appears in the VS-1. Attach additional pages if needed.
Last Name
First Name
MI
Title
Æ
SIGN
HERE
Date
Last Name
First Name
MI
Title
Æ
SIGN
HERE
Date
Last Name
First Name
MI
Title
Æ
SIGN
HERE
Date
reset/clear
VS-1PROV (2/17)
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