Form Vs-113i - Inspection Certificate Order Form
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1INSPECTION CERTIFICATE ORDER FORM
You can order stickers on the DMV web site at dmv.ny.gov/sticker
INSTRUCTIONS
1.
Use a separate form for each type of sticker you are ordering.
2. Check the box next to the type of sticker you are ordering.
3. Sign and date this order and enclose a check or money order payable to
COMMISSIONER OF MOTOR VEHICLES.
DO NOT SEND CASH.
4. Send a separate check with each form. Write your facility number on the check or money order.
5. Optional: If you would like your order returned by express delivery service, add $10.00 to the total cost of your order.
6. Please allow 2-3 weeks for processing and delivery.
7. Enclose this form and your check or money order and send them to:
Regular Mail
Express Mail
Bureau of Consumer & Facility Services
Vehicle Safety Services
PO Box 2700
6 Empire State Plaza
Albany NY 12220-0700
Room 220
Albany NY 12228
FACILITY INFORMATION
Facility Name
Facility Number
Address
City
State
Zip Code
EXPIRATION YEAR (check one)
.
Check the box for the type of sticker you need. Check only one
$80.00 per book:
$120.00 per book:
OR
o
o
Low Enhanced Emissions
Safety Only (new vehicles or trailers)
o
Motorcycle
o
Heavy Duty
o
Safety/Diesel Emission
Enter the number of books you are ordering and the amount owed:
___________________book(s) @ $_______________ each
= $ ____________________
(Quantity)
= $ ____________________
For return express delivery of stickers, add $10.00
TOTAL PAYMENT AMOUNT
= $ ____________________
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(Authorized Signature)
(Date)
(Print Name)
(E-Mail Address)
(Business Phone)
A $35.00 FEE WILL BE CHARGED FOR ALL RETURNED CHECKS!
VS-113I (9/17)
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