Form Evr-3 - Electronic Vehicle Registration Auto Dealer/business Partner Application
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1South Carolina Department of Motor Vehicles
EVR-3
ELECTRONIC VEHICLE REGISTRATION
(Rev. 4/15)
AUTO DEALER/BUSINESS PARTNER APPLICATION
NOTE: Form must be completed in its entirety. If space provided is insufficient, please reply on a separate sheet of
paper and attach as part of the application.
SECTION I. BUSINESS INFORMATION
Date:
First Time Application
Change Service Provider
Dealer Number/Business Partner FEIN:
Name of Dealership/Business Partner:
Physical Address for Dealership:
City:
State:
Zip Code:
Telephone Number: (
)
-
Mailing Address:
City:
State:
Zip Code:
SECTION II. OWNER/PRINCIPAL INFORMATION
1. Dealership/Business Partner Name (signer of the contract): __________________________________________
2. Name of Contact Person (person communicating with SCDMV): ______________________________________
3. Contact Person Telephone Number: _____________________________________________________________
4. Contact Person Email Address:_________________________________________________________________
5. Current Service Provider: _____________________________________________________________________
______________________________________________________________
Owner/Principal Signature
Mail to:
South Carolina Department of Motor Vehicles
EVRT QA Coordinator
P.O. Box 1498
Blythewood, South Carolina 29016-0055
______________________________________________________________
Date
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