Station Registration

Station Info

*Station Name:

*Doing Business As Name:

*FEIN #:

*Vermont Tax #:

*Phone Number:

Ext:

e.g. 802 123 4567 Ext: 12345

Fax Number:

Enter Fax # e.g. 802 123 4567

Is Internet Type Dial-up:

Yes

* Station Type:

Inspection License Type:

School Bus

Number Of Buses:

Motorcycle/Motor-Driven Cycle

Number Of Motorcycles:

Car/Truck/Heavy Duty Truck/Bus(Non-School Bus)/Trailer

Number Of Vehicles:

Station Physical Address

*State:

*City:

*Zip Code:

*Address:

Mailing Address is the same As Physical Address

Station Mailing Address

*State:

*City:

*Zip Code:

*Address:

Station Owner Contact Info

*First Name:

Middle Name:

*Last Name:

*Phone Number:

Ext:

Enter Phone # e.g. 802-123-4567 Ext: 12345

*Email:

*Enter the verification code characters shown on the left

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