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CALIFORNIA STATE FORM INSTRUCTIONS
The following information will assist you in completing the application to access MVRs in this state. Pages 1 –
4 of the attached document include the instructions directly from the California Department of Motor Vehicles to
complete the form; this is a summary of that information
1. The application must be completed and submitted, along with the applicable fee, directly to the state DMV
(address provided below). Once approved by the state, the confirmation letter – including your commercial
requestor code – from the DMV must be sent to IntelliCorp to establish account access
2. Please complete each section on the form in its entirety to avoid delays in processing your application. If the
requested information does not apply to your business insert n/a (not applicable) in that field.
Check One Only
• Original application: for use if this is the first time you are applying for MVR access in the state of
California
• Change(s) to existing account: for use if you are updating your company information on file with the
state DMV
• Renewal: for use if your organization already has access, and the access is going to expire (the
renewal period is 2 years)
Section A: Business Information
• Complete all fields: 1 – 10 in their entirety
o Enter your organization’s name as it is on file with the licensing agency/authority that granted
your license. Make sure you are specific as to LLC, LLP, etc.; the status will be verified by the
DMV
o List dba if applicable or insert n/a
Section B: Business Identification
• Complete all fields: 1 – 3 in their entirety
o Federal Employer ID# (FEIN) or State Tax ID#
o If your business is not a ‘corporation’, you must state your business type. If your organization is
not a California business, and you have no corporation #, insert n/a
o Enter the state from which your business license is issued
Section C: Business Type
• Select one
• If ‘other’ is selected, identify the type
Section D: Professional/Occupational License Information
• Complete all fields: 1, 2(a), 2(b), in their entirety
o If you are a licensed professional (i.e. attorney) – the name of the license holder (person) is to
be listed
o Enter the name of the agency that issued the license, include both the license number and
expiration date
• If you hold a professional/occupational license issued outside the state of California, a copy of the
license must be enclosed with the application
• If a Professional/Occupational License is not required for your organization, enter n/a in all fields
Section E: Commercial Requester Account History and Use
• Answer all questions: 1(a), 1( b), 2, 3 in their entirety
• If additional documentation is required, be certain to enclose it with the application
Section F: Record Access Method
• Answer both questions in their entirety
o Question 1
▪ Yes, IntelliCorp is a DMV approved Service Provider/Vendor
▪ Yes, the access method is online
o Question 2
▪ If you wish to access DMV’s through IntelliCorp, No, it is not necessary to obtain other
electronic information access
Section G: Permissible Use(s)/Purpose
• Complete all fields in their entirety
o Enter all types of permissible purposes applicable to your organization (pre-employment, etc.)
o Type – DL
o Check NO box for “Residence address requested”, UNLESS your organization is, per California
state statute, permitted to have access to address information. If you are permitted, you must
provide the specific statue that authorizes your access to addresses.
Section H: Acknowledgement and Certification Statement
• Complete all fields in their entirety
• Only a person who is authorized to execute contracts for your company should sign this form
Commercial Requester Account Addendum
• To be submitted with new and renewal applications
• Addendum to Agreement Number
o new account - leave field blank
o renewal – enter account # or assigned requestor code
Note: The form, along with the applicable fee, must be mailed directly to the California Department of Motor
Vehicles from your organization. IntelliCorp cannot process or receive DMV applications documents for the
state of California.
The forms must be mailed directly to the State of California Department of Motor Vehicles. The address is:
Department of Motor Vehicles
Accounts Processing Unit – MS H221
PO Box 944231
Sacramento, CA 94244-2310
If you have questions, you may reach the State of California Department of Motor Vehicles at the following
phone number: (916) 657-5564
Before you mail:
1. Has the form been completed in its entirety?
2. Has it been signed?
3. Is the application fee included? This should be made payable to “Department of Motor Vehicles”
a. The fee is $50.00 if you are not requesting address information
b. The fee is $250.00 is you are requesting address information
4. Have you made a copy for your records?
COMMERCIAL REQUESTER ACCOUNT
INSTRUCTIONS/APPLICATION
A Public Service Agency
Disclaimer
The information collected on the attached forms is public record
and open to inspection by the public, unless prohibited by statute.
INF 1133 (REV. 1/2007) WWW
Instructions for Completing the Commercial Requester Account (CRA) Application
Before You Begin
Incomplete applications result in processing delays. As you review the
following instructions, please take a moment to note any changes or
suggestions that you feel would make them more understandable. You
can make your comments or suggestions directly on the instructions
and return them with your application.
Be sure to read all instructions completely before filling out the forms
and keep a copy of all forms for your records;
DMV will not return
copies.
The Commercial Requester Account Application (INF 1106) is to be
used by “End Users”
ONLY
. An “End User” is any requester code
holder for whose use DMV record information (commonly referred to as
“Motor Vehicle Records (MVRs)” is requested. (Examples: Attorney/Law
Office, Auto Auction, Dealer, Financial Institution, Insurance Company,
Insurance Agent/Broker, Lien Sale Co., Registration Service, etc.)
If you are requesting access to DMV record information to provide a
pass-thru/reformat service to another approved requester (Vendor or
End User) or a person or entity who is authorized by another approved
End User to access, receive and use DMV record information on their
behalf, you must complete form INF 1106V “Commercial Requester
Account Service Provider Application” which is available on the DMV’s
website at www.dmv.ca.gov, click on “Other Services” and “Commercial
Requester Account” or by contacting the DMV’s Account Processing
Unit at (916) 657-5564.
Account Number
If you are an existing customer and are submitting a renewal or change
application, indicate the “account number” that has been issued by the
DMV. For first time applicants, the account number will be entered by
the DMV technician and included on your approval letter.
NOTE:
The “Account Number” was formerly referred to as the
“Agreement Number”.
Type of Application
($50 w/o residence address)
($250 w/residence address)
Original
– Check this box if you are applying for a new account.
All sections must be complete or the application will be returned
unprocessed.
Change
– Check this box if you have an existing account and you are
changing information, such as, the contact person, address, record
access method, permissible use, etc. Include all Requester Codes
currently issued.
Renewal
– If you have received a “renewal notice” (commonly referred
to as an “address insert sheet”) in the mail or your account is expiring,
check this box and complete all sections. Be sure to return your “renewal
notice(s)” with your renewal application.
Section A – Business Information
1.
Business Name...
– Enter the true full name of the sole proprietor
or each partner or corporation name as on file with the State of
Issuance.
NOTE:
The Corporation, LLC, LLP or LP status will be verified
and the Name or DBA provided must match. Inconsistencies will
result in processing delays.
Page 1
2.
Daytime Telephone Number
- Enter daytime telephone number
of applicant.
3. DBA
- Fictitious Business Name under which applicant will be doing
business.
4.
Internet Website Address
– Enter the Internet Website Address
of the business or indicate “None”.
5.
Fax Number
- Enter the fax number of the business or indicate
“None”.
6 thru 8. Contact Person, e-mail address, daytime phone
– Enter the
name/title, e-mail address (if available) and the daytime telephone
number of the person who will be responsible for the account and
who DMV can contact in the event of questions or problems.
9.
Street Address
– Enter the physical location where the business
is located including the street number and name, city and state.
10.
Mailing Address
– Enter the mailing address where you want
information mailed. If the mailing address is the same as the street
address provided in 9 above, indicate “Same”.
Section B – Business Identification
1.
Federal Employer ID Number (FEIN) or State Tax ID #
- The
FEIN or State Tax ID number is required on all applications. If you
wish to have an FEIN assigned, contact the IRS at (800) 829-1040.
If you are a sole proprietor, this may be the same as your Social
Security Number (SSN). SSN information collected as part of the
Commercial Requester Account application process will be used
strictly for collection of delinquent or administrative fines and will
not be released outside of the DMV.
2. Corporation Identification Number/State of Issuance
– Enter the
number
issued to the corporation, LLC, LLP, or LP and the
state
of issuance
, if applicable.
NOTE:
If your corporation is not located in California and your
state does not issue corporation numbers, you must list the state
in which you are incorporated and write “No Corp. # issued.”
3.
Other (Identify)
– If none of the above are applicable, identify your
business category (i.e., sole proprietor).
Section C – Business Type
Check the type of business in which you are involved. If none of the
business types listed are applicable, please check “Other” and identify
your business type.
Section D – Professional/Occupational License
Information
If the type of business identified in Section C is such that it requires
the applicant to be licensed by a state or federal agency in order to
engage in such business (i.e., an attorney must be licensed by the
state bar, insurance agent/broker must be licensed by the Department
of Insurance, registration service must be licensed by California DMV,
Occupational Licensing Section, etc.), please provide:
1.
Professional or Occupational Licensee Name
- the name of the
licensee as it appears at the registering agency (Example – John
Quincy Public)
2.
Issuing Agency Name
– the name of the state or federal agency
issuing such license (Example - California State Bar).
Print Instructions Pages 1-5
Instructions for Completing the Commercial Requester Account (CRA) Application
2.A.License Number
- the license number assigned to the applicant
(Example - 234567),
2.B.Expiration Date
- the expiration month and year of the license
(Example - 01/2004).
NOTE:
If you have been issued a professional/occupational
license in a state other than California, please attach a copy to
your application. The professional/occupational license may be
verified for active status and the name must match the name
identified in item D.1. Inconsistencies may result in processing
delays.
Section E – Commercial Requester Account History
and Use
1.a.
If you have or have had a Commercial Requester Account, including
renewals, check
“yes”
and print the business name or DBA and
the associated Agreement/Account number and Requester Code
number(s).
1.b.
Check
“yes”
if your previous account has been subject to a DMV
administrative action and attach a separate sheet of paper that
includes the type of action, the name of the person(s) and/or
business/DBA, the reasons and date of the action.
2.
If anyone having access to DMV record information has ever been
If you choose to request information directly from DMV, check
“No.”
DMV will establish an Automated Billing Information Service (ABIS)
account and you will be billed monthly by DMV for information
received.
2.
If you are interested in finding out about other electronic methods
of accessing information directly from DMV, such as, Cartridge
Tape (IBM compatible, 3480 non-compressed or 3490 compressed,
optional) or File Transfer Protocol via Virtual Private Network
(VPN), please contact the Electronic Access Administration Unit at
(916) 657-5582 for more information.
Section G – Permissible Use(s)/Purpose
Identify Proposed Use:
Use the space provided to explain your
purpose for requesting DMV records using a separate section for each
purpose.
NOTE:
DMV record information must be used only for the
purpose identified on your application (INF 1106) and approved
by DMV. Any other use is prohibited and could result in civil,
criminal, or administrative penalties. BE SPECIFIC.
Refer to “Permissible Use(s)” below for assistance/guidelines
in completing this information.
Type of Information Available:
convicted of any crime, as specified, check
“yes”
and attach a
separate sheet that includes the name of the person, the specific
x
VR
x
DL
x
OL
x
FR
code violation, conviction date, court and action taken.
3.a.
If you will be using the information for your own business use,
check this box. (Example – An applicant that is requesting DMV
record information in order to underwrite insurance for an insurance
company or perform a background pre-employment screening for
an employer.)
3.b.
If you will be providing a service to another applicant, such as, pass
through/reformat services (Vendor) or other contracted services,
(government agent) check this box.
Additional documents may
be required, contact Accounts Processing Unit (APU) at
(916) 657-5564.
Section F – Record Access Method
Commercial Requester Account applicants can purchase information
directly from DMV or from an approved Commercial Requester Account
Service Provider (AKA Vendor/Reseller) that has been authorized by
DMV to provide access to DMV records through a pass through/reformat
process. A list of authorized Commercial Requester Account Service
Providers is available on DMV website at www.dmv.ca.gov, click
on “Forms”, “Commercial Requester Accounts,” then scroll down to
“Reseller Vender List.”
1.
If you choose to request information from an approved Commercial
Requester Account Service Provider and not directly from DMV,
check
“Yes.”
You will be billed by the Service Provider for
information received from that Service Provider.
If you will be using the services of a Commercial Requester
Account Service Provider and you checked
“Yes”
above, does
that Service Provider offer on-line (instantaneous) access and will
you be requesting information through that on-line method? Check
appropriate box.
NOTE
: There is no on-line (instantaneous) access to financial
responsibility (FR) information. See Section G for further
information on how to obtain FR information.
Page 2
Mark the appropriate box(es) on the application for the type of DMV
information you are requesting.
VR
– A vehicle/vessel registration (VR) record contains information
relating to the registration of a vehicle or vessel.
DL
– A driver license/identification card (DL/ID) record contains
information obtained from an individual’s DL/ID application, abstracts
of convictions, and accidents.
OL
– Information regarding an Occupational Licensee (i.e., vehicle
salesperson, dealer, registration service, etc.)
FR
– Marking the box for financial responsibility (FR) information will
only allow the DMV to bill your Commercial Requester Account. For
obtaining FR information, you must submit form SR 19 to the FR Unit;
there is no on-line (instantaneous) access to FR information at this time.
The forms are available on the Internet or you can contact the FR Unit
at (916) 657-6677.
Permissible Use(s)
– Federal legislation, the Driver’s Privacy Protection
Act (DPPA), Title 18, United States Code, Sections 2721-2725, makes
any personal information contained in a motor vehicle record confidential
unless the information is requested and used for a “permissible use”
as defined below.
NOTE:
The identified “permissible uses” only authorize access
to non-confidential information. Confidential residence address
information will not be provided unless you qualify under a
separate state or federal statute. See “Residence Address
Requested…” for more information.
Government/Law Enforcement Agent
– Information received must be
used by a private person or entity acting on behalf of a Federal, State,
or local agency in carrying out the functions of the government/law
enforcement entity.
Instructions for Completing the Commercial Requester Account (CRA) Application
Motor Vehicle or Driver’s Safety and Theft
– Information received
must be used in connection with matters of motor vehicle or driver safety
and theft; motor vehicle emissions, motor vehicle product alterations,
recalls, or advisories; performance monitoring of motor vehicles, motor
vehicle parts and dealers; motor vehicle market research activities,
including survey research; and removal of non-owner records from the
original owner records of motor vehicle manufacturers.
Legitimate Business for Purposes of Preventing Fraud
– Information
received must be used in the normal course of business by a legitimate
business or its agents, employees, or contractors, but only to verify
the accuracy of personal information submitted by the individual to the
business or its agents, employees, or contractors; and if information as
so submitted is not correct or is no longer correct, to obtain the correct
information, but only for the purposes of preventing fraud by, pursuing
legal remedies against, or recovering on a debt or security interest
against the individual.
Civil, Criminal, Administrative or Arbitral Processing
- For use in
connection with any civil, criminal, administrative, or arbitral proceeding
in any Federal, State, or local court or agency or before any self-
regulatory body, including the service of process, investigation in
anticipation of litigation, and the execution or enforcement of judgments
and orders, or pursuant to an order of a Federal, State, or local court.
Research and Statistical Reports
- For use in research activities, and
for use in producing statistical reports, so long as the personal information
is not published, re-disclosed, or used to contact individuals.
Insurance Purposes
- For use by any insurer or insurance support
organization, or by a self-insured entity, or its agents, employees, or
contractors, in connection with claims investigation activities, anti-fraud
activities, rating or underwriting.
Towed or Impounded Vehicles
- For use in providing notice to the
owners of towed or impounded vehicles.
Private Investigator/Security Service
- For use by any licensed
private investigative agency or licensed security service for any purpose
permitted under this section.
NOTE:
A Private Investigator/Security Service MUST include the
other purpose permitted under this section. Example: Private
Investigator for Insurance Claims investigation.
Any Other Use Specifically Authorized Under California Law
- For
any other use specifically authorized under the law of the State that
holds the record, if such use is related to the operation of a motor
vehicle or public safety. (Include state law, identified by code name
and section number, which requires or permits use.) Example: “Service
of Summons pursuant to California Code of Procedure Section 415 et
seq.” or “News Gathering and Reporting pursuant to California Vehicle
Code Section 1808.”
Out-of-State Lien Sale
-Out-of-State Lien Sale applicants must attach
a copy of their state statute that requires DMV to release confidential
residence address information.
Residence Address Requested:
x
Yes
x
No
Section 1808.21 of the Vehicle Code states that all residence address
information within the department’s files is confidential, to be released
only to a court, law enforcement agency, or other government entity. If
you are requesting access to confidential residence address information,
you
MUST
cite the specific state or federal statute (by code name and
section number) that authorizes or requires the DMV to release that
information.
Page 3
For your convenience, DMV has provided a list of previously approved
statutes authorizing access to residence address information. The
California Vehicle Code is available on DMV’s website at www.dmv.
ca.gov then click on “Publications.”
NOTE:
It is the requester’s responsibility to read and ensure that
they are authorized under the identified statute. Administrative,
civil or criminal action may be taken for false representation.
Statutes that have been previously approved as authorizing access to
residence address information includes, but may not be limited to,:
•
California Vehicle Code Sections 1808.21 et al., 1808.22 et al.,
1808.23 et al., 1808.25, 4465, 22851.8,
•
California Civil Code Sections 3067 - 3075, inclusive
•
Harbors/Navigation Code Sections 500 - 509, inclusive
NOTE:
All requesters of residence address information MUST
provide the specific statute by code name and section number, in
order to request such information. Each statute will be reviewed
prior to approval.
EXAMPLES OF IDENTIFIED PURPOSES
Example # 1. Identify Proposed Use
Represent client in civil or criminal processes. Address authority CA
Vehicle Code § 1808.22(c)
Type:
x
VR
x
DL
x
OL
x
FR Residence address:
x
Yes No
Example # 2. Identify Proposed Use
For use by a legitimate business for preventing fraud in determining the
proper identity and driver license status of applicants for rental cars.
Type:
x
VR DL OL
FR Residence address:
Yes
x
No
NOTE:
Please note in item #1 that because residence address
access was requested, the authorizing statute by code name
and section number was included, as required.
Section H – Acknowledgement and Certification
Statement
The person signing the application must be an authorized representative
of the business and agree to all conditions set forth in the Commercial
Requester Account Terms and Conditions (INF 1230).
Section I – DMV Approval (DO NOT COMPLETE)
Once the application is approved, an approval letter will be mailed to you
with the requester code(s) that have been assigned to your business.
The approval letter will identify the permissible use/purpose(s) that have
been approved including whether residence address access has been
authorized. Your account will be activated immediately upon approval,
however, residence address information will not be released until your
Commercial Requester Account Surety Bond (INF 1132) is received
and approved by DMV. (See Checklist for further information). You may
immediately use your account to receive non-address records pending
receipt of your bond, if applicable.
Instructions for Completing the Commercial Requester Account (CRA) Application
CHECK LIST – ORIGINAL/RENEWAL APPLICATION
The following documents/items MUST be submitted
to the DMV for processing.
REQUIRED:
Commercial Requester Account Application (INF 1106)
ORIGINAL APPLICATION OR RENEWAL FEE:
Make check or money order payable to Department of Motor
Vehicles.
Account not requesting and/or authorized to receive confidential
residence address information
$50
Account authorized to and requesting access to confidential
residence address information
$250
NOTE:
$50 of the application fees is non-refundable and will be
retained by DMV.
No charge for changing contact person, address, phone number,
proposed use, etc.
NOTE:
Change of ownership will require “New” application and
fee.
ONLY IF APPLICABLE:
Commercial Requester Account Renewal Notice(s)
– DMV will
send notices approximately 90 days prior to expiration of a CRA.
If you have received a renewal notice, please return it to DMV with
your application.
Branch Location Requester Code(s) Application (INF 1106BL)
– Instructions are provided on the reverse of the form. Complete
and submit with completed application
only if
you are requesting
additional requester code(s) for branch locations as defined on
reverse of form.
NOTE:
The Branch Location Requester Code(s) Application (INF
1106BL) is only needed when you require additional requester
codes issued for your branch locations. An additional requester
code for branch locations would be required if you want to store
records at that branch or if you need to have information sent
directly from DMV to that branch.
ADDITIONAL REQUIREMENTS
Commercial Requester Account Terms & Conditions (INF 1230)
– By
signing the Commercial Requester Account Application (INF 1106), the
applicant is agreeing to comply with all terms and conditions contained
herein. Form INF 1230 must be retained on file by applicant/account
holder for frequent reference.
DO NOT RETURN TO DMV.
Information Security Statement (INF 1128)
– This form must be
completed upon presentation and re-certified annually by
ANY
individual
whether inside or outside your organization that has direct or incidental
access to DMV record information.
DO NOT RETURN TO DMV.
NOTE:
DMV form INF 1128 is replacing the previous
Representative Non-Disclosure Statement form (INF 1110). On
your next annual re-certification process, any person having
access to DMV record information, internal or external, must
complete DMV form INF 1128 which is to be maintained at the
account holder’s worksite and made available to DMV audit staff
upon request.
WHERE TO MAIL YOUR ORIGINAL/RENEWAL/
CHANGE APPLICATION
Congratulations,
You have now completed the CRA Application/
Renewal process. Mail your application and
applicable fee
to the
following address:
Department of Motor Vehicles
Accounts Processing Unit – MS H221
PO Box 944231
Sacramento, CA 94244-2310
If you need additional assistance, please contact your Service Provider
who will be able to assist you, or call the DMV at (916) 657-5564.
Please don’t forget that if you have any comments or suggestions
to improce the instructions, note them directly on the appropriate
page and send them with your application. All comments/
suggestions will be appreciated.
and return this form if you are a Dealer Agent (i.e., registration
service) who will be requesting residence address information in
order to process vehicle registration transactions/documents for a
vehicle dealer
OR
if you are a Manufacturer Agent processing recall
advisories for a vehicle manufacturer.
NOTE:
Each licensed dealer or manufacturer for whom you will
be processing work must sign form INF 1184. All INF 1184 forms
must be submitted to DMV and DMV notified upon termination
of contractual relationship.
NOTE
: If you request and are approved by DMV to access
confidential residence address information, DMV will mail you
the CRA Bond form (INF 1132) for you to complete. Please do
not submit the bond form until you are notified by DMV that you
have been approved for residence address information.
Page 4
Certification of Agency (INF 1184)
– You are required to complete
Information Services Branch
COMMERCIAL REQUESTER ACCOUNT
A Public Service Agency
APPLICATION
Account Number
DMV USE ONLY
AMOUNT
EXPIRES
Check One Only: Original Application (All sections must be completed or application will be returned unprocessed.)
Change(s) to existing Account—Complete only those sections that are changing and list ALL existing
Requester Code(s) (REQUIRED)
Renewal (All sections must be completed or application will be returned unprocessed.)
IMPORTANT
TO AVOID PROCESSING DELAYS, PLEASE READ ALL INSTRUCTIONS PRIOR TO COMPLETING FORM.
SECTION A. BUSINESS INFORMATION
1. BUSINESS NAME
2. DAYTIME T
( )
ELEPHONE NUMBER
3. DBA (FICTITIOUS BUSINESS NAME)
4. INTERNET WEBSITE ADDRESS (IF NONE, SO STATE)
5. FAX NUMB
ER
6. CONTACT PERSON NAME/TITLE (INDIVIDUAL RESPONSIBLE FOR THE ACCOUNT)
7. E-MAIL ADDRESS
8. DAYTIME T
( )
ELEPHONE NUMBER
9. STREET ADDRESS (PHYSICAL LOCATION REQUIRED)
CITY
STATE
ZIP CODE
10. MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)
CITY
STATE
ZIP CODE
SECTION B. BUSINESS IDENTIFICATION
1. FEDERAL EMPLOYER ID# OR STATE TAX ID #
2. CORPORATION, LLC, LLP, LP ID#, IF APPLICABLE
Number:
STATE OF ISSUANCE
3.
OTHER (PLEASE IDENTIFY)
Attorney/Law Office
Auto Auction
Dealer (Vehicle/Vessel)
Dismantler (Vehicle/Vessel)
Distributor (Vehicle/Vessel)
Financial Institution
Hospital/Clinic
Independent Institution of Higher Education
Insurance Agent/Agency/Broker
Insurance Company
Lessor/Retailer
Lien Sale
Manufacturer (Vehicle/Vessel)
Media
PI/Detective Agency
Process Server
Registration Service
Rental Company (Vehicle/Vessel)
Salvage Company
Other: (Please Identify)
1.
PROFESSIONAL OR OCCUPATIONAL LICENSEE NAME
1.
Has anyone directly affiliated with any party identified in Section A:
a.
previously applied for, had, or have a Commercial Requester Account? Yes No
If yes, print Business Name and/or DBA
Agreement/Account or Requester Code #
and
b.
been subject to a DMV administrative action? Yes No
If yes, attach a separate sheet that includes the type of action, the name of the person and/or business, the reason and date of
incident.
2.
Has anyone having access ever been convicted of any crime for a violent act, stalking, computer fraud, or for unauthorized
disclosure, access or distribution of information? Yes No
If yes, attach a separate sheet that includes the name of the person, the specific code violation, conviction date, court, and action
taken.
3.
a. I will be using the information for my own business use as approved by the department.
b. I will be using the information to perform a legitimate business service on behalf of another CRA applicant (i.e., pass
through/reformat, other contracted services) as approved by the department. Access authority will be based on the other
CRA applicant
INF 1106 (REV. 11/2006)
SECTION D. PROFESSIONAL/OCCUPATIONAL LICENSE INFORMATION
SECTION C. BUSINESS TYPE
2. ISSUING AGENCY NAME
A. LICENSE NUMBER
B. EXPIRATION DATE (MONTH/YEAR)
SECTION E. COMMERCIAL REQUESTER ACCOUNT HISTORY AND USE
INF 1106
1.
Will you obtain information through a DMV approved Service Provider/Vendor? Yes No
If “Yes”, is the access method on-line? (Instant response) Yes No
If “No”, please provide a mailing address where you would like your invoices sent. If address is the same as the mailing address
identified in Section A, please state “Same”:
2.
Are you interested in other electronic information access directly from the DMV? Yes No
If “yes”, see instructions for other access methods and who to contact.
I hereby acknowledge that I have received, read, and agree to the Commercial Requester Account Terms and Conditions (INF 1230).
I understand that the use, or unauthorized disclosure, of departmental information for a purpose other than that for which this
applicant applied, and was approved by the Department, is prohibited and subject to criminal prosecution, including fines and
imprisonment. (California Vehicle Code Section 1808.45) I further understand that obtaining departmental information under false
representations, the distribution of restricted information, or use of information for a purpose not specified by this applicant and
approved by the Department, may result in suspension/revocation of applicant’s access privileges and civil penalties up to $100,000.
(California Vehicle Code Section 1808.46)
I certify (or declare) under penalty of perjury under of the laws of the State of California that the foregoing is true and correct. I further
consent to receive service of process pursuant to the provisions of California Vehicle Code Section 1808.21(c).
EXECUTED AT CITY COUNTY ON (DATE)
SIGNATURE OF AUTHORIZED REPRESENTATIVE
X
PRINTED NAME TITLE DAYTIME TELEPHONE NUMBER
( )
SECTION I. DMV APPROVAL
STATE OF CALIFORNIA
Department of Motor Vehicles
SIGNATURE (DMV REPRESENTATIVE)
DATE
X
IMPORTANT
Information provided on this form is Public Record, unless expressed otherwise in statute.
Any confidential information will not be released to the general public.
Applicant must retain a copy of the application for their records.
Mail To: DMV, Account Processing Unit
MS-H221, P.O. Box 944231,
Sacramento, CA 94244-2310
INF 1106 (REV. 11/2006)
SECTION H. ACKNOWLEDGEMENT AND CERTIFICATION STATEMENT
No
Yes
FR Residence address requested:
OL
DL
VR
Type:
Proposed Use Approved
Yes No
Requester Code Issued
#
4. IDENTIFY PROPOSED USE
No
Yes
FR Residence address requested:
OL
DL
VR
Type:
Proposed Use Approved
Yes No
Requester Code Issued
#
3. IDENTIFY PROPOSED USE
No
Yes
FR Residence address requested:
OL
DL
VR
Type:
Proposed Use Approved
Yes No
Requester Code Issued
#
2. IDENTIFY PROPOSED USE
No
Yes
FR Residence address requested:
OL
DL
VR
Type:
Proposed Use Approved
Yes No
Requester Code Issued
#
1. IDENTIFY PROPOSED USE
For DMV Use Only
SECTION G. PERMISSIBLE USE(S)/PURPOSE - Each permissible use must be listed separately.
SECTION F. RECORD ACCESS METHOD
INF 1106
A Public Service Agency
Information Services Branch
COMMERCIAL REQUESTER ACCOUNT
TERMS AND CONDITIONS
Department of Motor Vehicles (DMV) reserves
the right to modify the following terms and
conditions at will.
A.
GENERAL
By applying for a Commercial Requester
Account to access DMV information, you, the
“Requester” agree to the following:
1. The term of the Commercial Requester
Account shall be for two years from date of
approval and may be renewed biennially or
extended by the department.
2. Requester shall not sell or transfer
ownership of a vehicle or vessel if the
information received from the files of the
DMV indicates a Department of Justice stop
(“DOJ STOP”). Requester shall notify the
local police regarding the vehicle or vessel
whenever the location of the vehicle or
vessel is known.
3. Requester agrees to defend, indemnify and
hold harmless the DMV and its officers,
agents and employees from any and all
claims, actions, damages or losses which
may be brought or alleged against the DMV,
its officers, agents or employees by reason
of the negligent, improper, or unauthorized
use or dissemination by the Requester or its
officers, agents, or employees, of
information furnished to the Requester by
the DMV or by reason of inaccurate
information furnished to the Requester by
the DMV unless the Requester can show
that the DMV was originally furnished
accurate information from the reporting
source.
INF 1230 (NEW 3/2004)
4. Requester shall not represent itself as an
agent or employee of the DMV. Requester
shall not use any DMV trade mark or service
mark, indicia or any substantial similarity
thereto or acronym in a manner likely to
cause confusion that Requester’s services
are associated with or are that of the DMV.
5. Requester and its designees shall use DMV
information for purpose(s) for which it
requests an account and is approved by the
DMV. Any other use(s) is strictly prohibited
and will subject the Requester and its
designees to termination of account as well
as civil and criminal penalties.
6. Requester shall notify DMV in writing
within ten (10) days of any changes
including but not limited to address,
telephone number, contact person, closure
or sale of business.
7. Commercial Requester Account and
attendant Requester code(s) are personal to
the Requester and no rights or
responsibilities under this agreement are
assignable by Requester.
8. Resale of DMV information is prohibited.
Requester shall not store, combine or link
department information with any database
for resale or for any business purpose(s) not
specified on the application for a
Commercial Requester Account approved
by the DMV. Continued storage of
information is permissible to comply with
federal or state record retention
requirements.
9. Requester’s access to DMV information
may be modified and/or terminated
•
immediately with cause
•
without cause upon 30 days notice by
either party
INF 1230
B.
SECURITY
1.
Requester shall comply with all DMV
security requirements relating to its
Commercial Requester Account. Requester
understands that the DMV reserves the right
to amend or enhance its requirements and
continuance of a Commercial Requester
Account is contingent upon Requester’s
compliance with the updated criteria.
Security requirements are available at
www.dmv.ca.gov (click on “Other
Services”). It is the responsibility of the
account holder to periodically review this
website, but no less than once every 6
months, for any future updates or
enhancements to the security requirements.
Requester affirms that it has, or has access
to, the internet that will allow them to view
the website for current and updated security
requirements.
2.
Requester shall be responsible for
safeguarding the information received and
shall restrict access to this information to
its employees, agents or parties with whom
it contracts. Requester agrees to be held
responsible for any misuse of the
information by its employees, agents or
parties to whom the information was
entrusted.
C.
RESIDENCE ADDRESS
If receiving residence address information, the
Requester shall secure a surety bond in the
amount of $50,000 and is subject to the
provisions of California Code of Regulations
(CCR) §350.24.
D.
FEES
1.
Requesters receiving information directly
from the DMV shall be charged a fee
pursuant to CCR §350.44 and shall be billed
monthly for information received.
2.
The amount listed on the invoice is due and
payable upon receipt. Failure to remit the
appropriate payment could result in
termination of your requester privileges and
may include a referral to a collection agency.
E.
DISPUTES
1.
Requester may withhold payment of any
disputed charges. A “charge” is not disputed
until Requester provides the DMV a written
explanation of the disputed charge within
30 days of invoice date. If the DMV
determines the charges are valid, the
Requester will be notified and shall pay all
such charges within (10) ten days.
2.
Requester consents to jurisdiction of
California courts and the Requester agrees
to Sacramento County, California as the
forum selected for judicial review of its
rights relating to its account under these
terms and conditions. Any disputes
regarding the Requester’s account shall be
adjudicated pursuant to the laws of the State
of California.
3.
The person authorized to complete and sign
the application on behalf of the Requester
may be held personally responsible to the
DMV for any debts and obligations arising
under this agreement.
F.
INSPECTION OF RECORDS
1. Requester shall keep its records required
pursuant to CCR §350.18(b) (4) and CCR
§350.48 at the business address provided
to the DMV.
2. Requester’s place of business shall be
available for an electronic or manual audit
(of records required to be retained)
immediately upon request from the DMV
or the DMV’s representative.
3. Requester understands that failure to
respond timely to an audit report with
findings, may result in inactivation/
cancellation of the Requester code.
INF 1230 (NEW 3/2004)
INF 1230
A Public Service Agency
COMMERCIAL REQUESTER ACCOUNT
BRANCH LOCATION REQUESTOR CODE(S) APPLICATION
See Instructions on Reverse
Page of
Billing Address: Check one box only Main Office Branch Location
STREET ADDRESS (PHYSICAL LOCATION REQUIRED)
CITY
STATE
ZIP CODE
MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)
CITY
STATE
ZIP CODE
RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV)
STREET CITY STATE ZIP CODE
CORPORATION OR OCCUPATIONAL LICENSE NUMBER OF BRANCH
REQUESTER CODE ACCESS
Same as Main Office
Basic record only
DMV USE ONLY
Requester Code(s)
CONTACT PERSON/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS) E-MAIL ADDRESS DAYTIME TELEPHONE NUMBER
( )
STREET ADDRESS (PHYSICAL LOCATION REQUIRED)
CITY
STATE
ZIP CODE
MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)
CITY
STATE
ZIP CODE
RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV)
STREET CITY STATE ZIP CODE
CORPORATION OR OCCUPATIONAL LICENSE NUMBER OF BRANCH
REQUESTER CODE ACCESS
Same as Main Office
Basic record only
DMV USE ONLY
Requester Code(s)
CONTACT PERSON/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS)
E-MAIL ADDRESS
DAYTIME TELEPHONE
( )
NUMBER
STREET ADDRESS (PHYSICAL LOCATION REQUIRED)
CITY
STATE
ZIP CODE
MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)
CITY
STATE
ZIP CODE
RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV)
STREET CITY STATE ZIP CODE
CORPORATION OR OCCUPATIONAL LICENSE NUMBER OF BRANCH
REQUESTER CODE ACCESS
Same as Main Office
Basic record only
DMV USE ONLY
Requester Code(s)
CONTACT PERSON/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS)
E-MAIL ADDRESS
DAYTIME TELEPHONE
( )
NUMBER
STREET ADDRESS (PHYSICAL LOCATION REQUIRED)
CITY
STATE
ZIP CODE
MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)
CITY
STATE
ZIP CODE
RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV)
STREET CITY STATE ZIP CODE
COMPLETED BY (NAME AND TITLE) DATE
x
IMPORTANT
Information provided on this form is Public Record. Information that is confidential according to statute will be masked prior to release.
Applicant must retain a copy of the application for their records.
INF 1106BL (REV. 3/2004)
SECTION A: Main Office
NAME OF BUSINESS
REQUESTER CODE(S) (IF ISSUED)
ACCOUNT NUMBER (IF ISSUED)
SECTION B: Branch Locations
CORPORATION OR OCCUPATIONAL LICENSE NUMBER OF BRANCH
REQUESTER CODE ACCESS
Same as Main Office
Basic record only
DMV USE ONLY
Requester Code(s)
CONTACT PERSON NAME/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS)
E-MAIL ADDRESS
DAYTIME TELEPHONE NUMBER
( )
INF 1106BL
INSTRUCTIONS FOR COMPLETING THE COMMERCIAL REQUESTER ACCOUNT
BRANCH LOCATION REQUESTOR CODE(S) APPLICATION
IMPORTANT
KEEP COPIES OF ALL FORMS FOR YOUR RECORDS PRIOR TO SUBMITTING THEM TO THE DMV.
COPIES WILL NOT BE RETURNED
For purposes of completing this application, a “Branch Location” is defined as “an offshoot, lateral extension, or division of an
institution with a separate physical location.” In order to be enrolled as a Branch Location, the branch must be operating under
the same corporate number or Occupational License as the account holder. If separate corporation numbers or Occupational
License numbers are indicated, they must complete an application for a separate Commercial Requester Account (CRA).
There are no additional application fees for branch locations.
Main Office or Branch Location Billing Information – Each branch location will be issued a separate requester code. The
monthly billing invoice is automatically mailed to the branch location (when information is received directly from the DMV)
unless you indicate that you want the billing invoice mailed to the main office. Check the appropriate box where you want billing
invoices mailed.
Note: This only applies if information is being purchased directly from the DMV.
Complete as many copies of form INF 1106BL as needed but be sure to provide the Name of the Business on each form and
number them properly (i.e., 1 of 22). In addition, include the Requester Code Number(s) and Account Number(s), if already
issued, of the account holder.
Complete for each branch location as follows:
Corporation or Occupational License # of Branch – Provide the Corporation or Occupational License # under which the
branch location is operating. Please remember, if the branch location has a separate Corporation or Occupational License, they
must complete an application for a separate CRA.
Requester Code Access – If the main office and specified branch locations are to have the same type of access, mark “Same
as Main Office.” If the Main Office is authorized to and is receiving residence address information and the branch locations are
to be restricted to basic record information only (i.e., no residence addresses), mark “Basic record only”.
DMV USE ONLY – Leave Blank.
Contact Person Name/Title, E-Mail Address, Daytime Phone – Please provide the name, e-mail address (if applicable) and
daytime phone number of the individual who will be responsible for the branch location’s access.
Street Address – Please provide the physical address of the branch location including number, street, city, state and zip.
Mailing Address – Please provide the mailing address of the branch location where you would like DMV information mailed.
If same as street address, state “Same”.
Record Storage Address – Please provide the physical location where records will be maintained for on-site inspection,
review or audit by DMV or designated representative.
INF 1106BL (REV. 3/2004)
WHAT IS A BRANCH LOCATION?
FEE:
BILLING INFORMATION:
SECTION A
SECTION B
INF 1106BL
A Public Service Agency
INFORMATION SERVICES BRANCH
INFORMATION SECURITY STATEMENT
By signing this form, the undersigned represents that he/she has read and understands the same, agrees to its contents and
realizes the penalties for non-compliance to its terms.
The California Department of Motor Vehicles (CA DMV) collects information from the public to administer the various
programs for which it has responsibility. CA DMV is committed to protect this information from unauthorized access, use, or
disclosure. The following have been adopted to address commercial and governmental users responsibilities for handling and
protecting information obtained from the CA DMV. I understand the following are my responsibilities:
1. I may access information only when necessary to accomplish the responsibilities of my employment. I may not access or
use information from the CA DMV for personal reasons. (Examples of inappropriate access or misuse of CA DMV
information include, but are not limited to: making personal inquiries or processing transactions on my own records or
those of my friends or relatives; accessing information about another person, including locating their residence address,
for any reason that is not related to my job responsibilities.)
2. I may disclose CA DMV information only to individuals who have been authorized to receive it through the appropriate
procedures as regulated by CA DMV. Requesters of information must complete the appropriate forms, submit them to CA
DMV as specified, and pay all applicable fees. In the case of confidential or personal information, a proper accounting of
all disclosures must be made and the subject must be notified in accordance with statute and CA DMV directives.
(Examples of unauthorized disclosures include, but are not limited to: telling someone the address of another person
when it is not an authorized disclosure or part of my job responsibilities.)
3. To keep the requester code and/or password confidential, I must take reasonable precautions to maintain the secrecy of
any requester code and/or my password. Reasonable precautions include, but are not limited to, not telling or allowing
others to view my password or requester code; securing my terminal with a locking device if one has been provided;
storing user documentation to sensitive programs in a secure place; to destroy CA DMV information in a manner that it
cannot be reproduced or identified in any physical or electronic form; and reporting any suspicious circumstances or
unauthorized individuals I have observed in the work area to my supervisor, if applicable.
4. To promptly notify your manager or supervisor of any indication of misuse or unauthorized disclosure of information
obtained from CA DMV.
Federal law states:
“Any person who knowingly obtains, discloses, or uses personal information from a motor vehicle record for a purpose
not permitted under the Driver’s Privacy Protection Act (Title 18 of the United States Code, Section 2721 – 2725), shall
be liable to the individual to whom the information pertains, who may bring a civil action in a United States district court.
I certify under penalty of perjury, under the laws of the State of California, that I have read and understand the security
policies stated above. I understand that failure to comply with these policies and regulations may result in disciplinary action in
accordance with state and federal laws and regulations, and/or civil or criminal prosecution in accordance with applicable
statutes. I further understand that I may undergo disciplinary action from my employer up to and including termination from
employment.
EXECUTED AT
CITY
COUNTY
STATE ZIP CODE
SIGNATURE
X
DATE
PRINTED NAME OF SIGNATORY
GOVERNMENT OR COMMERCIAL ENTITY REPRESENTATIVE
NAME OF GOVERNMENT OR COMMERCIAL ENTITY
This form must be completed upon presentation and re-certified annually and RETAINED AT THE WORKSITE of the Requester Account
Holder with a current list of those authorized direct or incidental record access for the life of the account and for two years following the
deactivation or termination of the account. This completed form and list must be made available upon request to DMV audit staff.
INF 1128 (REV. 9/2006)
To be completed by any individual having access to DMV record information. Annual re-certification is required. (See reverse)
INF 1128
ANNUAL RE-CERTIFICATION
I have read and understand the security policies stated within the Information Security Statement. I understand that failure
to comply with these policies may result in disciplinary action in accordance with Section 19572 of the government Code,
federal laws and regulations, and/or civil or criminal prosecution in accordance with applicable statutes.
PRINTED NAME
SIGNATURE
DATE
INF 1128 (REV. 9/2006)
INF 1128
A Public Service Agency
INFORMATION SERVICES
CERTIFICATION OF AGENCY
PLEASE CHECK THE APPROPRIATE BOX BELOW:
My business is a vehicle dealership licensed to do business in the state of California.
My business is a vehicle manufacturer licensed to do business in the state of California.
PLEASE PRINT THE FOLLOWING INFORMATION REGARDING YOUR OWN BUSINESS:
NAME
ADDRESS STREET CITY STATE ZIP CODE
I hereby certify, under penalty of perjury, that the party specified below is authorized to act as my agent for the
purpose of obtaining information from the Department of Motor Vehicles pursuant to Vehicle Code Section
1808.23.
In making this authorization, I agree to:
Hold the Department harmless from any monetary loss to the Department by reason of the use of informa-
tion obtained from the Department by this agent; and
Pay to the Department, its officers, and any other person(s) all civil damages occasioned to the Department
or such persons by reason of the following acts or omissions by this agent:
(a)
obtaining information from the Department by means of false or misleading representations, or
(b)
selling, giving, or otherwise furnishing any information obtained from Department records to any third
party not specifically authorized and approved by the Department.
PLEASE PRINT THE FOLLOWING INFORMATION REGARDING THE AGENT YOU ARE AUTHORIZING
NAME
ADDRESS STREET CITY STATE ZIP CODE
I certify, under penalty of perjury, that the foregoing is true and correct.
EXECUTED AT CITY COUNTY STATE
INF 1184 (NEW 2/91)
DEALER/MANUFACTURER LICENSE NUMBER
DAYTIME TELEPHONE NUMBER
( )
DRIVER LICENSE NUMBER
TELEPHONE NUMBER
( )
DATE
SIGNATURE OF DEALER OR MANUFACTURER
X
INF 1184
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