Minnesota Department of Public Safety State Patrol Division
Fill out information to the right.
Please type or print your
name and mailing
address legibly. Please provide unattached
return label(s).
Company Telephone Number
Company Name
Mailing Address
City State Zip Code
Decals are available for the current year and one preceding year. Decals for the following
year will be available beginning December 1. Decals are not refundable or
exchangeable. Please order carefully. Decals are $2.00 each.
What year decals do you want to purchase?
How many decals do you want to purchase?
Total due for decals $ (Do not include credit card fee.)
Make check payable to STATE OF MINNESOTA. (Please do not attach check stub or staple to orders)
Mail order form and remittance to: MN State Patrol Commercial Vehicle Section
1110 Centre Pointe Curve #410
Mendota Heights, MN 55120
If you have any questions about the decal order, please call the Minnesota State Patrol at (651)350-2000.
Credit Card Orders: For your security, we do not accept credit card orders by e-mail or fax. Please mail your order to the above
address. A service charge of $4.50 is assessed for each credit card order. On Orders for multiple inspectors - the card number
only needs to be entered on the top form.
Credit Card Number Month/Year
It is hereby agreed this inspector will recognize the critical criteria established by the State Patrol Division of the Department of
Public Safety, and shall place decals only upon vehicles that have passed inspection as provided by law.
Should it ever be determined this inspector has issued decals without regard to all provisions set forth in 49 CFR 396.17 and
MS 169.781, the privileges of performing certified inspections may be revoked.
Decals listed below are to be used only by the inspector who has signed this form. Use by any other person is strictly prohibited.
Agreed by:
Certified Inspector’s Signature Date Inspector Certification Number
Print Inspector Name Company Name
For Office Use Only
Beginning Decal # Ending Decal #
Transaction Type: CC_____ Check_____ Cash_____
Date Issued Issued by
(Revised 12/28/2020)
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