Request For Vehicle / Driver Information
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1REQUEST FOR VEHICLE/DRIVER INFORMATION
Record Lookup Fee is $11.00 – Certified Record Lookup is $12.00
Clear Form
Print Form
The lookup fee applies per record found. Fees are also charged for “no record” results.
Today’s Date
Delivery Method
Account Name and Mailing Address
Your Account #
Mail
/
/
Email*
Your Phone Number
Email Address for Account
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Claim #
Your Fax Number
*Emails will be delivered to the
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-
account's email address.
Attn:
*Records must be saved or printed
after download.
Vehicle Record Information
Check box if you want a certified copy ($1.00 additional fee)
*Only italicized record types can be emailed.
Complete
Title
Registration History
Lien holder
Ownership
Partial
Title
Registration History From
/
/
To
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/
(History information is $11.00 per record found)
Plate Number
Vehicle Year and Make
Accident/Occurrence Date
Vehicle Identification Number
Watercraft/Snowmobile #’s
Any and All Vehicles Registered to an Individual/Company
*Only italicized record types can be emailed.
For “Any and All” requests, please check one box only:
All motor vehicles
All Assets (mobile home, snowmobile, mopeds, etc.)
(Including motor vehicles)
You must give us both the name and the address – the cost is $11.00 per record
Name of Person (First Name, Last Name, Jr. or Sr.)
Address (Street, City, State)
Use the above lines ONLY for “Any and All” record requests.
Driver Record Information
Check box if you want a certified copy ($1.00 additional fee)
*Only italicized record types can be emailed.
Please circle your primary reason for the request
Court
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Employment
Insurance
Credit
Other
Driver License Number
&
Full Name (First, Middle, Last)
&
Date of Birth
/
/
/
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/
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/
Complete the following
Complete
Address
Application History
for record histories:
Partial
Address
Application History
From
/
/
To
/
/
(History information is $11.00 per record found)
ATTACH ADDITIONAL PAGES IF NECESSARY
BDVR-153 (09/16)
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Parent category: Business