Read New Jersey Motor Vehicle Commission text version

CORPCODE REQUEST FORM To be completed by company owner and/or executive officer

Legal Name of Company: _________________________________________________ Federal Tax Payer ID# / Federal Employer ID#: ________________________________ Phone #:_______________________________ Mailing Address: ________________________________________________________ City: __________________________________State: ______ Zip: _________________ Street Address if mailing address is a PO Box: _________________________________ Business Description: _____________________________________________________ Will your vehicle(s) be principally garaged at this location? ___Yes No____ If not, where will the vehicle(s) be garaged? ___________________________________ Name of Executive Requesting Corpcode: _____________________________________ Relationship to Company: __________________________________________________ Driver License Number: __________________________________ State: ___________

Note: A photocopy of the valid driver license of the company official completing this form and of the individual granted Power of Attorney, if applicable, must be attached to this document. The party submitting application at a motor vehicle agency will be required to show their original document.

Social Security Number: __________________________________

Submission of the Social Security Number if required by N.J.A.C.13:21-1.3. The number will be used to prevent errors, enforce Federal and State laws and assist in the collection of motor vehicle fees.

Does your company currently have any vehicles registered in this state? ___Yes ___No

If yes, please complete the following information for one of the vehicles:

VIN or Hull#: ___________________________________ Plate#: _________________ Make: _________________ Model: _________________ Year: _____________

I certify that I am requesting a corpcode because the applicable vehicles will be principally garaged in New Jersey for use by the above legally operated company and that I am legally present in this country.

Signature:____________________________Title:__________________Date:_________ MVC Only: Agency:____________ID checked by:_______________Date:___________ Approved Corpcode#: _____________________________________________________ Approval Date:__________________________ AHL employee:____________________

BA-8 (Revised 8/04)

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New Jersey Motor Vehicle Commission

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