MVDB 9 (07/01/2020)
DEALER PLATE APPLICATION
BUSINESS TRADING AS NAME DEALER CERTIFICATE NUMBER
BUSINESS ADDRESS BUSINESS TELEPHONE NUMBER
CITY STATE ZIP CODE
Total # Decals Total # Plates
For Initial Applicants: You are allowed 4 plates per salesperson. Minimum 2 plates per plate type.
INSURANCE CERTIFICATION (check one box)
I/we certify that vehicles owned or assigned to my firm are insured by a policy issued through an insurance company licensed to do
business in Virginia and that the policy provides at least the minimum amount of coverage as required by § 46.2-1547 Code of
Virginia. I have attached a copy of my Certificate of Liability Insurance as proof of insurance coverage on each dealer plate.
A certificate of self-insurance number ________________________________ has been issued by DMV pursuant to §46.2-368 for
the series of dealer's license plates issued.
NOTE: AUTOMOBILE LIABILITY INSURANCE MUST BE MAINTAINED ON EACH DEALER'S LICENSE PLATE FOR AS LONG AS THAT PLATE REMAINS
VALID.
CERTIFICATION
I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to MVDB are genuine, and that the
information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand
that knowingly making a false statement or representation on this form is a criminal violation.
OWNER, PARTNER OR OFFICER NAME (print)
OWNER, PARTNER OR OFFICER SIGNATURE
DATE (mm/dd/yyyy)
AGENCY USE ONLY
PRORATED PLATE FEE CHART (no refund on plates)
Months Car - Truck - Motorcycle - Recreational Vehicle - Trailer
TOTAL MONTHS OF
REGISTRATION
FIRST 2 PLATES
EACH ADDITIONAL
PLATE FEE
ADDITIONAL FEE
FOR RESERVED
PLATES
12 months 60.00 26.00 10.00
11 months 55.00 23.83 9.17
10 months 50.00 21.67 8.33
9 months 45.00 19.50 7.50
8 months 40.00 17.33 6.67
7 months 35.00 15.17 5.83
6 months 30.00 13.00 5.00
5 months 25.00 10.83 4.17
4 months 20.00 8.67 3.33
3 months 15.00 6.50 2.50
2 months 10.00 4.33 1.67
1 month 5.00 2.17 .83
NEW OR ADDITIONAL PLATES REQUEST
Indicate Number of Additional Plates Requested
CAR / TRUCK MOTORCYCLE
RECREATIONAL VEHICLE TRAILER
REPLACEMENT PLATE / DECAL REQUEST
Plate Replacement for Lost / Stolen / Damaged Plate(s) (circle one)
Indicate plate numbers below. Fee $10.00 (includes decals).
PLATE NUMBER PLATE NUMBER PLATE NUMBER
Decal Replacement Only
Indicate month and/or year below. Fee $1.00 each.
MONTH YEAR
