Scribd
Upload
170 views1 page

Inf1123 Request For Vehicle-Vessel Automated Record Information

This document is a request form for vehicle/vessel automated record information from a Public Service Agency. It contains fields for requester information like vendor name, telephone number and agreement number. It also includes fields for describing up to 15 vehicles/vessels with details like VIN/HIN numbers, license/CF numbers, and service requested. The requester must sign and provide their driver's license/ID number before submitting the original and one copy of the completed form to the Department of Motor Vehicles.

Uploaded by

Steve Smith
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
170 views1 page

Inf1123 Request For Vehicle-Vessel Automated Record Information

This document is a request form for vehicle/vessel automated record information from a Public Service Agency. It contains fields for requester information like vendor name, telephone number and agreement number. It also includes fields for describing up to 15 vehicles/vessels with details like VIN/HIN numbers, license/CF numbers, and service requested. The requester must sign and provide their driver's license/ID number before submitting the original and one copy of the completed form to the Department of Motor Vehicles.

Uploaded by

Steve Smith
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

DATE PAGE NO.

A Public Service Agency REQUEST FOR VEHICLE/VESSEL


AUTOMATED RECORD INFORMATION ATTN

VENDOR REQUESTER CODE


PLEASE PRINT OR TYPE — FORM MUST BE COMPLETED AND SUBMITTED IN DUPLICATE
VENDOR NAME TELEPHONE NO. VENDOR AGREEMENT NO.

( )
VEHICLE/VESSEL DESCRIPTION INFO/SERVICE REQUESTED
VIN/HIN Automated
User Requester Code User Agreement No. License/CF No. Required for Lien Sale History Years Certify
(5 bytes) (6 bytes) (7 bytes) (17 bytes) (4 bytes) As of Date

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

TOTAL NO. OF REQUESTS REQUESTED BY (SIGNATURE) DRIVER LICENSE/ID NO.

OPERATOR NO. AND DATE VERIFIED BY TECH: DATE RECEIVED


DMV USE ONLY

MAIL TO: DEPARTMENT OF MOTOR VEHICLES, ISB Commercial Operations H265, P. O. BOX 944247, SACRAMENTO, CA 94244-2470
INF 1123 (REV. 1/2002) ORIGINAL AND ONE COPY TO DMV
Print Clear Form

You might also like