Form Mv-93.1 - Secure Power Of Attorney (Mv-93) Order Form
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1SECURE POWER OF ATTORNEY
(MV-93) ORDER FORM
dmv.ny.gov
INSTRUCTIONS FOR THIS ORDER FORM
To order a supply of Secure Power of Attorney forms (MV-93):
1. Complete each section of this form. Be sure to sign and date the Authorization section.
2. Enclose a check or money order payable to
COMMISSIONER OF MOTOR VEHICLES. DO NOT SEND CASH.
3. Write your facility number on your check or money order.
4. Optional: If you would like your order shipped by express delivery service, please add $10.00 to
the total cost of your order.
5. Send this form to DMV:
BY REGULAR MAIL
BY EXPRESS DELIVERY
Bureau of Consumer & Facility Services
Vehicle Safety Services
PO Box 2700
6 Empire State Plaza, Room 220
Albany NY 12220-0700
Albany NY 12228
FACILITY INFORMATION
Facility Name
Facility Number
Address
City
Zip Code
ORDER INFORMATION
Secure Power of Attorney forms (MV-93) are available in packages of 25 forms and cost $125.00 for
each package.
0
______________ packages @ $125.00 each
= $ ________________________
(Quantity)
________________________
= $
Optional express delivery of order (add $10.00)
0
________________________
= $
TOTAL PAYMENT AMOUNT
AUTHORIZATION
Authorized Signature
Date
ç
Print Name
Business Phone
E-mail Address
A $35.00 FEE WILL BE CHARGED FOR ALL RETURNED CHECKS!
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MV-93.1 (2/15)
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