Rental Agency Application for Utah Title and Registration
Section 1 - New Owner Name and Address Information
Owner Type - Check One Primary Owner's Name Co-Owner's Name Individual Lessor Trust Business
Clear form
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(Individuals use Last, First, Middle Initial, if Business use DBA)
Relationship to Co-Owner: And Or
and list on back)
(Last, First, Middle Initial) (if Street address is different from above, check here
Street Address (Primary Owner) Mailing Address (Primary Owner), if different from Street Address
City
State
ZIP Code
City
State
ZIP Code
Section 2 - Lessee Name and Address Information
Lessee Type - Check One Lessee's Name Street Address Mailing Address, if different from Street Address Individual Trust Business Relationship to Co-Lessee: And Or City State ZIP Code
(Individuals use Last, First, Middle Initial, if Business use DBA)
City
State and list on back)
ZIP Code
Co-Lessee's Name (Last, First, Middle Initial) (if Street address is different from above, check here
Section 3 - Vehicle and Registration Information Contribute $2 to: ATV-Off Highway Fund Missing or incorrect information may result in rejected application. Trailer (Length: ___________ feet) MSRP: $ _______________ Passenger
Street Motorcycle Light truck, Van, or Utility Heavy truck (over 12,000 lbs) Registered Wt. _________________ Off-Highway Manufactured Housing Snowmobile
ATV/Motorcycle
Friends For Sight Outboard Motor
Organ Donation Support
Watercraft (Length: ft_____ in_____) Personal watercraft (Length: ft_____ in_____) Unit Number If Branded Title, Brand Type
Small motor vehicle (CC ________ Horsepower ________)
Enter mileage, no tenths
Cylinders Fleet Number Fuel Type
Color of vehicle/vessel (required) _____________________ Make VIN/HIN/Serial Number Year
License Plate Type - Life Elevated Arches plates will be issued unless otherwise indicated. Life Elevated Arches Life Elevated Skier Other: City State ZIP Code Situs address of vehicle/vessel, if different from Street Address above (no P.O. box)
Signature of officer or agent: This signature certifies that an officer or agent physically inspected the Vehicle Identification Number described above and found it to be correct. X_______________________________________________________________ Date signed _________________
Section 4 - Lien Holder Information
Lien Holder Name Mailing Address City State ZIP Code
Section 5 - Purchase and Dealer Information
Purchase Date Permit Issue Date Permit Number Dealer Number Dealer/Authorized Representative Signature New Used Date
Section 6 - Rental Agency Authorized Signature
Federal and Utah laws allow you to decide if you want your motor vehicle information Public: may be disclosed to any business or individual, otherwise the record will be Protected: only disclosed to government agencies, law enforcement, or private entities having a legitimate business need.
Protected record status applies to all owner's of record
Yes - Make my motor vehicle record information Public
I declare that I am the owner of the vehicle/vessel described on this application and that all the above information is accurate and true. I/we certify that I will maintain in effect owner's or operator's security (insurance) for this vehicle/vessel as required by law in order to operate this vehicle/vessel on a highway, quasi-public road, parking area, or waterway within this state. Owner's Signature Date Owner's Signature Date TC-656R MVA Rev. 8/07