TS-4 www.hctax.net Rev. 03/19
Motor Vehicle Title Service Runner Authorization Form
Please complete this printable form online, or write legibly in blue or black ink ONLY, within the lines provided.
This form will NOT be accepted, and will be returned if it is illegible, altered, or incomplete.
Mot
or Vehicle Title Service Runner Authorization to be completed by Title Service Owner (employer).
Title Service Business Name:
Badge Expiration (mm/yy):
Valid Texas DL or ID Number:
The
following individual is authorized to act as a Motor Vehicle Title Service Runner for the above listed company.
Full Legal Name of Runner (first, middle, last):
Runner Residence Address:
Runner Phone Number:
Alternate Number:
Valid Texas DL or ID Number:
Badge Expiration (mm/yy):
Printed Name of Runner: _____________________________________________
Date: ______________________
Signature of Runner: ______________________________________________________________________________
NOTE: You are required to notify us immediately of any changes that would interfere with your Motor Vehicle
Title Service Runner License.
Warning: Falsifying information on any required statement or government document is a criminal offense,
and is punishable by fine and/or imprisonment.
