Form Psb-3 - Name Selection Form For Private Service Bureau (Psb) Applicants

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NAME SELECTION FORM FOR
PRIVATE SERVICE BUREAU (PSB) APPLICANTS
The New York State Department of Motor Vehicles (DMV) must pre-approve the name that you select for
BEFORE
your private service bureau (PSB)
you submit an “Application for a License to Operate a Private
Service Bureau or Open a Branch Office” (form MV-372).
Please enter up to three names that you would like DMV to consider, then fax this form to (518) 474-7369
PRIOR
for approval
to the submission of your application. If a fax machine is not available, please call
(518) 473-6586 for assistance. You will be notified of which name has been approved.
NOTE:
NOT
To avoid public confusion, DMV will
approve a name that contains “DMV” or “Motor Vehicle”.
Name Selection Requests
1.
________________________________________________________________________
2.
________________________________________________________________________
3.
________________________________________________________________________
Requester’s Information
Name: ______________________________________________________________________________
-
Phone Number:
(
)
area code
** INCOMPLETE APPLICATIONS WILL RESULT IN THE REJECTION OF YOUR APPLICATION **
reset/clear
PSB-3 (12/16)

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