Form Pv-0105 - Rental Company Initial Enrollment Application (Page 2 of 2) in pdf

Form Pv-0105 - Rental Company Initial Enrollment Application Page 2

SECTION II - CORPORATE CERTIFICATION

The undersigned affirms that the lessor is in the business of renting and/or leasing vehicles and that all

of the vehicles that will be enrolled in the Car Rental Program will be used for rental or leasing purposes.

____________________________________________

__________________________________________

Print Name of Corporate Officer

Title

____________________________________________

__________________________________________

Corporate Officer’s Signature

Date

SECTION III - FEE INFORMATION

Complete Section IV before completing this Section

1. Enter number of Plates enrolled (total # listed as “A” in Trans Code column in Section IV below):

________________________

2. Enter total enrolled Months (Effective Date column in Section IV below):

________________________

3. Multiply Plates X Months (multiply total on Line 1 by total on Line 2):

________________________

. Amount Enclosed (should equal total on line 3):

5. Check Number:

$_____________________

________________________

SECTION IV - VEHICLE PLATE INFORMATION

Enter the vehicle Plate Number, State and Plate Type for each vehicle.

Enter

for Zero.

For Car

(additions should be as of 1st of the month only)

TRANSACTION CODES

ADD PLATE

Rental

(terminations as of the end of the month)

TERMINATE PLATE

Unit Use

ADDITION

TERMINATION

TRANS

EFFECTIVE DATE

Only

(

)

(

)

CODE

PLATE NUMBER

STATE

PLATE TYPE

FORMAT MMDDYYYY

Termination Date:

# of “A” Keyed:

# of “T” Keyed:

Keyed by:

Visit Finance at nyc.gov/finance

Form Pv-0105 - Rental Company Initial Enrollment Application Page 2

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