INSPECTION CERTIFICATE ORDER FORM
You can order stickers on the DMV web site at dmv.ny.gov/sticker
INSTRUCTIONS
Facility Number
Facility Name
Address
City
State
Zip Code
FACILITY INFORMATION
EXPIRATION YEAR (check one)
TYPE OF STICKER (check one)
PAYMENT
Enter the number of books you are ordering and the amount owed:
book(s) @ $ each
= $
(Quantity)
For return express delivery of stickers, add $10.00
= $
TOTAL PAYMENT AMOUNT
= $
X
(Authorized Signature)
(Print Name)
(Business Phone)
(E-Mail Address)
(Date)
1. Use a separate form for each type of sticker you need to order.
2. Enter your facility information.
3. Check the box next to the expiration year and type of sticker you want to order.
4. Enter all information in the payment section, including your signature and the date.
5. Make a check or money order payable to “
COMMISSIONER OF MOTOR VEHICLES.” DO NOT SEND CASH.
4. Send a separate check with each form. Write your facility number on the check or money order.
5. Optional: To have your order returned by express delivery service, add $10.00 to your total payment amount.
6. Allow 2-3 weeks for processing and delivery.
7. Mail this form with your check or money order to one of the following addresses:
Regular Mail
Express Mail
Bureau of Consumer & Facility Services
Vehicle Safety Services
PO Box 2700
6 Empire State Plaza, Room 220
Albany NY 12220-0700
Albany NY 12228
Check the box for the expiration year of the stickers you are ordering. Check only one
.
Expiration Year 2021 (
BLUE
)
Expiration Year 2022 (
GRAY
)
OR
(To be issued in 2020)
(To be issued in 2021)
Check the box for the type of sticker you need. Check only one.
$80.00 per book:
$120.00 per book:
OR
Low Enhanced Emissions
Safety Only (new vehicles or trailers)
Motorcycle
Heavy Duty
Safety/Diesel Emission
VS-113I (9/20)
A $35.00 FEE IS CHARGED FOR ALL RETURNED CHECKS!
