Commercial Requester Account Form – Fill Out and Use This PDF

Before You Begin

Incomplete applications result in processing delays.As you review the following instructions, please take a moment to note any changes or suggestions that you feel would make them more understandable.You can make your comments or suggestions directly on the instructions and return them with your application.

Be sure to read all instructions completely before illing out the forms and keep a copy of all forms for your records; DMV will not return copies.

The Commercial Requester Account Application (INF 1106) is to be used by “End Users” ONLY. An “End User” is any requester code holder for whose use DMV record information (commonly referred to as “Motor Vehicle Records (MVRs)” is requested. (Examples:Attorney/ Law Office, Auto Auction, Dealer, Financial Institution, Insurance Company, Insurance Agent/Broker, Lien Sale Co., Registration Service, etc.)

Effective January 1, 2012, electrical corporations, as deined in Public Utilities Code (PUC) §218; local publicly owned electric utilities, as deined in PUC §224.3; and agents of these entities are authorized to obtain residence address information for the purpose of identifying where electric vehicles are registered. The corporations, public utilities, and agents must have an approved requester code account to obtain residence address information from the department.

If your electrical corporation or local publicly owned electric utility:

•Qualiies as a commercial requester:

—Follow the instructions to complete and submit the Commercial Requester Account Application (INF 1106), and other required documents contained in this packet.

•Does not qualify as a commercial requester:

—Refer to the Government Requester Account Instructions/ Application (INF 40) packet on the DMV Internet website at: www.dmv.ca.gov.

Effective January 1, 2011, if you will be acting as an authorized contractor on behalf of an insurance company, pursuant to a contractual agreement; and will request residence address access for the purpose of obtaining the address of another motorist or vehicle owner involved in an accident with the insurance company’s insured; you must apply for a Commercial Requester Code Account. Additionally, you must comply with the following requirements:

•Provide a copy of each contract with any insurance company that has a contractual agreement with you for the purposes described above. Submit the document(s) with the Commercial Requester Account Application (INF 1106).

•Submit copies of all new or renewal contracts, as speciied that become effective after applying for and obtaining a Commercial Requester Code Account. (Mail these documents to the DMV - Accounts Processing Unit. The Unit’s address is provided at the end of the instructions.)

•Retain the contract(s) for audit purposes.You must produce the document(s) immediately upon request.

If you are requesting access to DMV record information to provide a pass-thru/reformat service to another approved requester (Vendor or End User) or a person or entity who is authorized by another approved End User to access, receive and use DMV record information on their behalf, you must complete form INF 1106V “Commercial Requester Account Service Provider Application” which is available on the DMV’s website at www.dmv.ca.gov, click on “Other Services” and

“Commercial Requester Account” or by contacting the DMV’s Account Processing Unit at (916) 657-5564.

Account Number

If you are an existing customer and are submitting a renewal or change application, indicate the “account number” that has been issued by the DMV. For irst time applicants, the account number will be entered by the DMV technician and included on your approval letter.

NOTE: The “Account Number” was formerly referred to as the “Agreement Number”.

Type of Application

($50 w/o residence address) ($250 w/residence address)

Original – Check this box if you are applying for a new account. All sections must be complete or the application will be returned unprocessed.

Change – Check this box if you have an existing account and you are changing information, such as, the contact person, address, record access method, permissible use, etc. Include all Requester Codes currently issued.

Renewal – If you have received a “renewal notice” (commonly referred to as an “address insert sheet”) in the mail or your account is expiring, check this box and complete all sections. Be sure to return your “renewal notice(s)” with your renewal application.

Section A – Business Information

1.Business Name... – Enter the true full name of the sole proprietor or each partner or corporation name as on ile with the State of Issuance.

NOTE: The Corporation, LLC, LLP or LP status will be veriied and the Name or DBA provided must match. Inconsistencies will result in processing delays.

2.DaytimeTelephone Number - Enter daytime telephone number of applicant.

3.DBA - Fictitious Business Name under which applicant will be doing business.

4.Internet Website Address – Enter the Internet Website Address of the business or indicate “None”.

5.Fax Number - Enter the fax number of the business or indicate “None”.

6 thru 8. Contact Person, e-mail address, daytime phone – Enter the name/title, e-mail address (if available) and the daytime telephone number of the person who will be responsible for the account and who DMV can contact in the event of questions or problems.

9.Street Address – Enter the physical location where the business is located including the street number and name, city and state.

10.Mailing Address – Enter the mailing address where you want information mailed. If the mailing address is the same as the street address provided in 9 above, indicate “Same”.

Section B – Business Identiication

1.Federal Employer ID Number (FEIN) or State Tax ID # - The FEIN or State Tax ID number is required on all applications. If you wish to have an FEIN assigned, contact the IRS at (800) 829-

1040. If you are a sole proprietor, this may be the same as your Social Security Number (SSN). SSN information collected as part of the Commercial Requester Account application process will be used strictly for collection of delinquent or administrative ines and will not be released outside of the DMV.

2.Corporation Identiication Number/State of Issuance – Enter the number issued to the corporation, LLC, LLP, or LP and the state of issuance, if applicable.

NOTE: If your corporation is not located in California and your state does not issue corporation numbers, you must list the state in which you are incorporated and write “No Corp. # issued.”

3.Other (Identify) – If none of the above are applicable, identify your business category (i.e., sole proprietor).

Section C – Business Type

Check the type of business in which you are involved. If none of the business types listed are applicable, please check “Other” and identify your business type.

Section D – Professional/Occupational License Information

If the type of business identiied in Section C is such that it requires the applicant to be licensed by a state or federal agency in order to engage in such business (i.e., an attorney must be licensed by the state bar, insurance agent/broker must be licensed by the Department of Insurance, registration service must be licensed by California DMV, Occupational Licensing Section, etc.), please provide:

1.Professional or Occupational Licensee Name - the name of the licensee as it appears at the registering agency (Example

– John Quincy Public)

2.Issuing Agency Name – the name of the state or federal agency issuing such license (Example - California State Bar).

2.A.License Number - the license number assigned to the applicant (Example - 234567),

2.B.Expiration Date - the expiration month and year of the license (Example - 01/2004).

NOTE: If you have been issued a professional/occupational license in a state other than California, please attach a copy to your application. The professional/occupational license may be veriied for active status and the name must match the name identiied in item D.1. Inconsistencies may result in processing delays.

Section E – Commercial Requester Account History and Use

1.a. If you have or have had a Commercial Requester Account, including renewals, check “yes” and print the business name or DBA and the associated Agreement/Account number and Requester Code number(s).

1.b. Check “yes” if your previous account has been subject to a DMV administrative action and attach a separate sheet of paper that includes the type of action, the name of the person(s) and/ or business/DBA, the reasons and date of the action.

2.If anyone having access to DMV record information has ever been convicted of any crime, as speciied, check “yes” and attach a separate sheet that includes the name of the person, the speciic code violation, conviction date, court and action taken.

3.a. If you will be using the information for your own business use, check this box. (Example – An applicant that is requesting DMV record information in order to underwrite insurance for an insurance company or perform a background pre-employment screening for an employer.)

3.b.If you will be providing a service to another applicant, such as, pass through/reformat services (Vendor) or other contracted services, (government agent) check this box. Additional documents may be required, contact Accounts Processing Unit (APU) at (916) 657-5564.

Section F – Record Access Method

Commercial Requester Account applicants can purchase information directly from DMV or from an approved Commercial Requester Account Service Provider (AKA Vendor/Reseller) that has been authorized by DMV to provide access to DMV records through a pass through/reformat process.A list of authorized Commercial Requester Account Service Providers is available on DMV website at www.dmv. ca.gov, click on “Forms”, “Commercial Requester Accounts,” then scroll down to “Reseller Vender List.”

1.If you choose to request information from an approved Commercial Requester Account Service Provider and not directly from DMV, check “Yes.”You will be billed by the Service Provider for information received from that Service Provider.

If you will be using the services of a Commercial Requester Account Service Provider and you checked “Yes” above, does that Service Provider offer on-line (instantaneous) access and will you be requesting information through that on-line method? Check appropriate box.

NOTE: There is no on-line (instantaneous) access to inancial responsibility (FR) information. See Section G for further information on how to obtain FR information.

If you choose to request information directly from DMV, check “No.” DMV will establish an Automated Billing Information Service (ABIS) account and you will be billed monthly by DMV for information received.

2.If you are interested in inding out about other electronic methods of accessing information directly from DMV, such as, Cartridge Tape (IBM compatible, 3480 non-compressed or 3490 compressed, optional) or File Transfer Protocol via Virtual Private Network (VPN), please contact the ElectronicAccessAdministration Unit at (916) 657-5582 for more information.

Section G – Permissible Use(s)/Purpose

Identify Proposed Use: Use the space provided to explain your purpose for requesting DMV records using a separate section for each purpose.

NOTE: DMV record information must be used only for the purpose identiied on your application (INF 1106) and approved by DMV. Any other use is prohibited and could result in civil, criminal, or administrative penalties. BE SPECIFIC.

Refer to “Permissible Use(s)” below for assistance/

guidelines in completing this information.

Type of Information Available:  VR  DL  OL  FR

Mark the appropriate box(es) on the application for the type of DMV information you are requesting.

VR – A vehicle/vessel registration (VR) record contains information relating to the registration of a vehicle or vessel.

DL – A driver license/identiication card (DL/ID) record contains information obtained from an individual’s DL/ID application, abstracts of convictions, and accidents.

OL – Information regarding an Occupational Licensee (i.e., vehicle salesperson, dealer, registration service, etc.)

FR – Marking the box for inancial responsibility (FR) information will only allow the DMV to bill your Commercial Requester Account. For obtaining FR information, you must submit form SR 19 to the FR Unit; there is no on-line (instantaneous) access to FR information at this time. The forms are available on the Internet or you can contact the FR Unit at (916) 657-6677.

Permissible Use(s) – Federal legislation, the Driver’s Privacy Protection Act (DPPA), Title 18, United States Code, Sections 2721- 2725, makes any personal information contained in a motor vehicle record conidential unless the information is requested and used for a “permissible use” as deined below.

NOTE: The identiied “permissible uses” only authorize access to non-conidential information. Conidential residence address information will not be provided unless you qualify under a separate state or federal statute. See “Residence Address Requested…” for more information.

Motor Vehicle or Driver’s Safety and Theft – Information received must be used in connection with matters of motor vehicle or driver safety and theft; motor vehicle emissions, motor vehicle product alterations, recalls, or advisories; performance monitoring of motor vehicles, motor vehicle parts and dealers; motor vehicle market research activities, including survey research; and removal of non- owner records from the original owner records of motor vehicle manufacturers.

Legitimate Business for Purposes of Preventing Fraud – Information received must be used in the normal course of business by a legitimate business or its agents, employees, or contractors, but only to verify the accuracy of personal information submitted by the individual to the business or its agents, employees, or contractors; and if information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for the purposes of preventing fraud by, pursuing legal remedies against, or recovering on a debt or security interest against the individual.

Civil, Criminal, Administrative or Arbitral Processing - For use in connection with any civil, criminal, administrative, or arbitral proceeding in any Federal, State, or local court or agency or before any self-regulatory body, including the service of process, investigation in anticipation of litigation, and the execution or enforcement of judgments and orders, or pursuant to an order of a Federal, State, or local court.

Research and Statistical Reports - For use in research activities, and for use in producing statistical reports, so long as the personal information is not published, re-disclosed, or used to contact individuals.

Insurance Purposes - For use by any insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or contractors, in connection with claims investigation activities, anti- fraud activities, rating or underwriting.

Towed or Impounded Vehicles - For use in providing notice to the owners of towed or impounded vehicles.

Private Investigator/Security Service - For use by any licensed private investigative agency or licensed security service for any purpose permitted under this section.

NOTE: A Private Investigator/Security Service MUST include

the other purpose permitted under this section. Example: Private Investigator for Insurance Claims investigation.

Any Other Use Speciically Authorized Under California Law - For any other use speciically authorized under the law of the State that holds the record, if such use is related to the operation of a motor vehicle or public safety. (Include state law, identiied by code name and section number, which requires or permits use.) Example: “Service of Summons pursuant to California Code of Procedure Section 415 et seq.” or “News Gathering and Reporting pursuant to California Vehicle Code Section 1808.”

Out-of-State Lien Sale-Out-of-State Lien Sale applicants must attach a copy of their state statute that requires DMV to release conidential residence address information.

Residence Address Requested:  Yes  No

Section 1808.21 of the Vehicle Code states that all residence address information within the department’s iles is conidential, to be released only to a court, law enforcement agency, or other government entity. If you are requesting access to conidential residence address information, you MUST cite the speciic state or federal statute (by code name and section number) that authorizes or requires the DMV to release that information.

For your convenience, DMV has provided a list of previously approved statutes authorizing access to residence address information. The California Vehicle Code is available on DMV’s website at www.dmv. ca.gov then click on “Publications.”

NOTE: It is the requester’s responsibility to read and ensure that they are authorized under the identiied statute. Administrative, civil or criminal action may be taken for false representation.

Statutes that have been previously approved as authorizing access to residence address information includes, but may not be limited to:

•California Vehicle Code Sections 1808.21 et al., 1808.22 et al., 1808.23 et al., 1808.25, 4465, 22851.8,

•California Civil Code Sections 3067 - 3075, inclusive

•Harbors/Navigation Code Sections 500 - 509, inclusive

NOTE: All requesters of residence address information MUST provide the speciic statute by code name and section number, in order to request such information. Each statute will be reviewed prior to approval.

EXAMPLES OF IDENTIFIED PURPOSES

Example # 1. Identify Proposed Use

Represent client in civil or criminal processes. Address authority CA Vehicle Code § 1808.22(c)

Type:  VR  DL  OL  FR 

Residence address:  Yes No

Example # 2. Identify Proposed Use

For use by a legitimate business for preventing fraud in determining the proper identity and driver license status of applicants for rental cars.

Type:  VR DL OL FR 

Residence address: Yes  No

NOTE lease note in item 1 tat ecause residence
address access as reedtaut	istatute y
code name and section numas includedas reed.

Section Acement tiic

Stement

e person signing te application must e an auto	ried
representatie otusiness and agree to all conditions set ort
in tommercial Reer ccount erms and onditions (INF
1230).

Section I – ApproT COMPLETE

tapplication is approedan approal letter mailed
to you treer code(s) te assigned to your
usiness. e approal letter ill identiy te per	missile use/
purpose(s) te approed including residence
address access autied.our account actiated
immediately upon approal oeer residence addre	ss inormation
ill not e released until your ommercial Reueste	r ccount urety
ond (INF 1132) is receied and approed y V. (	ee eclist or
urter inormation).ou may immediately use your	account to receie
noness records pending receipt oour le.
CT – ORIAL APPLICATION
Tolloems MUST te
to tor processing
REQUIRE
Commercieer Account Applic
ORIAPPLICATION OR RENEWAL
Me cor moneorple to tment of Motor
eles
ccount not reuesting and/or autoried to recei	e conidential
residence address inormation
ccount autoried to and reuesting access to con		idential
residence address inormation
NOTE otapplication ees is nonele and
etained y .
No carge or canging contact person address p	one numer
proposed use
NOTE oosree “Ne application
and ee.
ONLAPPLICA
CommerciReer Account ReneNotice		–
send notices approely days prior to eation oa
Iyou e receied a reneal noticeplease return it to
our application.
rnc Loction Reuester Coes Appliction IN
– Instructions are proon treerse otorm.
omplete and sumit it completed application	onl if	you are
readditional reer code(s) or anclocations as
deined on reerse oorm.
NOTE e ranc ocation Reuester ode(s) pplication
(INF 110is only needed you ree additional
reuester codes issued or your ranc locations.		n

Pge

additional reer code or anclocations ould reed iyou ant to store records at tancor i you need to e inormation sent directly om to tanc

Certiiction of Agenc IN	– ou are reuired to
complete and return torm iyou are a gent (i.e.
registration serreresidence address
inormation in order to process eicle registratio		n transactions/
documents or a edealer	OR iyou are a uacturer
gent processing recall adies or a euacturer.
NOTE Eac licensed dealer or manuacturer or om you
processing ormust sign orm INF 11 INF
11orms must suted to and notiied
upon termination oactual relations.
NOTE Iyou reand are approed y to access
conidential residence address inormationmail
you t orm (INF 1132) or you to complete.
lease do not sumit te ond orm until you are no		tiied y
tyou e approed or residence address
inormation.

AUIREMENTS

Commercil Reuester Account Terms	Conitions IN
– signing tommercial Reer ccount
(INF 110tapplicant is agreeing to comply all terms and
conditions contained ein. Form INF 1230 must retained on
ile y applicant/account older or reuent reere		nce. O NOT
RETURN TO
InformSecuritStement	– orm must

completed upon presentation and recertiied annuall y y AN indiual tr inside or outside your organition tt as direct

or incidental access to record inormation.	NOT RETURN
TO

NOTE V orm INF 112 is replacing te preious Representatie Nonisclosure tatement orm (INF

1110). n your net annual recertiication process any person access to record inormationinternal

or eernalmust complete orm INF 112is to maintained at taccount ’s ore and made aailale to ae

WTO MAILOUR ORIAL/

CAPPLICATION

Congrul	ou e nocompleted t
Reneal process. your application and		le fee	to t

olloess

tment oor Ve ccounts rocessing

acramento0

I you need additional assistance please contact yo ur erice ro ale to assist youor call t at (

lease don’t orget tat i you ae any comments o	r
suggestions to improe te instructions note tem
directly on tappropriate page and send tyour
application.comments/suggestions appreciated.

A Public Service Agency

Information Services Branch

COMMERCIAL REQUESTER ACCOUNT

APPLICATION

Account Number ____________

DMV USE ONLY

CHECK/M.O. #	AMOUNT
CA ID/DATE	EXPIRES

Check One Only:

Original Application (All sections must be completed or application will be returned unprocessed.) Change(s) to existing Account—Complete only those sections that are changing and list ALL existing Requester Code(s) _____________________________________________ (REQUIRED)

Renewal (All sections must be completed or application will be returned unprocessed.)

1. FEDERAL EMPLOYER ID# OR STATE TAX ID # 2. CORPORATION, LLC, LLP, LP ID#, IF APPLICABLE

Number:

3.OTHER (PLEASE IDENTIFY)

STATE OF ISSUANCE

Attorney/Law Office

Auto Auction

Dealer (Vehicle/Vessel)

Dismantler (Vehicle/Vessel)

Distributor (Vehicle/Vessel)

Financial Institution

Hospital/Clinic

Independent Institution of Higher Education

Insurance Agent/Agency/Broker

Insurance Company

Lessor/Retailer

Lien Sale

Manufacturer (Vehicle/Vessel)

Media

PI/Detective Agency

Process Server

Registration Service

Rental Company (Vehicle/Vessel)

Salvage Company

Other: (Please Identify)

2.Are you interested in other electronic information access directly from the DMV? If “yes”, see instructions for other access methods and who to contact.

Yes

No

Department of Motor Vehicles (DMV) reserves the right to modify the following terms and conditions at will.

A. GENERAL

By applying for a Commercial Requester Account to access DMV information, you, the “Requester” agree to the following:

1.The term of the Commercial Requester Account shall be for two years from date of approval and may be renewed biennially or extended by the department.

2.Requester shall not sell or transfer ownership of a vehicle or vessel if the information received from the files of the DMV indicates a Department of Justice stop (“DOJ STOP”). Requester shall notify the local police regarding the vehicle or vessel whenever the location of the vehicle or vessel is known.

3.Requester agrees to defend, indemnify and hold harmless the DMV and its officers, agents and employees from any and all claims, actions, damages or losses which may be brought or alleged against the DMV, its officers, agents or employees by reason of the negligent, improper, or unauthorized use or dissemination by the Requester or its officers, agents, or employees, of information furnished to the Requester by the DMV or by reason of inaccurate information furnished to the Requester by the DMV unless the Requester can show that the DMV was originally furnished accurate information from the reporting source.

4.Requester shall not represent itself as an agent or employee of the DMV. Requester shall not use any DMV trade mark or service mark, indicia or any substantial similarity thereto or acronym in a manner likely to cause confusion that Requester’s services are associated with or are that of the DMV.

5.Requester and its designees shall use DMV information for purpose(s) for which it requests an account and is approved by the DMV. Any other use(s) is strictly prohibited and will subject the Requester and its designees to termination of account as well as civil and criminal penalties.

6.Requester shall notify DMV in writing within ten (10) days of any changes including but not limited to address, telephone number, contact person, closure or sale of business.

7.Commercial Requester Account and attendant Requester code(s) are personal to the Requester and no rights or responsibilities under this agreement are assignable by Requester.

8.Resale of DMV information is prohibited. Requester shall not store, combine or link department information with any database for resale or for any business purpose(s) not specified on the application for a Commercial Requester Account approved by the DMV. Continued storage of information is permissible to comply with federal or state record retention requirements.

9.Requester’s access to DMV information may be modified and/or terminated

•immediately with cause

•without cause upon 30 days notice by either party

B. SECURITY

1.Requester shall comply with all DMV security requirements relating to its Commercial Requester Account. Requester understands that the DMV reserves the right to amend or enhance its requirements and continuance of a Commercial Requester Account is contingent upon Requester’s compliance with the updated criteria. Security requirements are available at www.dmv.ca.gov (click on “Other Services”). It is the responsibility of the account holder to periodically review this website, but no less than once every 6 months, for any future updates or enhancements to the security requirements. Requester affirms that it has, or has access to, the internet that will allow them to view the website for current and updated security requirements.

2.Requester shall be responsible for safeguarding the information received and shall restrict access to this information to its employees, agents or parties with whom it contracts. Requester agrees to be held responsible for any misuse of the information by its employees, agents or parties to whom the information was entrusted.

C. RESIDENCE ADDRESS

If receiving residence address information, the Requester shall secure a surety bond in the amount of $50,000 and is subject to the provisions of California Code of Regulations (CCR) §350.24.

D. FEES

1.Requesters receiving information directly from the DMV shall be charged a fee pursuant to CCR §350.44 and shall be billed monthly for information received.

2.The amount listed on the invoice is due and payable upon receipt. Failure to remit the appropriate payment could result in termination of your requester privileges and may include a referral to a collection agency.

E. DISPUTES

1.Requester may withhold payment of any disputed charges. A “charge” is not disputed until Requester provides the DMV a written explanation of the disputed charge within 30 days of invoice date. If the DMV determines the charges are valid, the Requester will be notified and shall pay all such charges within (10) ten days.

2.Requester consents to jurisdiction of California courts and the Requester agrees to Sacramento County, California as the forum selected for judicial review of its rights relating to its account under these terms and conditions. Any disputes regarding the Requester’s account shall be adjudicated pursuant to the laws of the State of California.

3.The person authorized to complete and sign the application on behalf of the Requester may be held personally responsible to the DMV for any debts and obligations arising under this agreement.

F. INSPECTION OF RECORDS

1.Requester shall keep its records required pursuant to CCR §350.18(b) (4) and CCR §350.48 at the business address provided to the DMV.

2.Requester’s place of business shall be available for an electronic or manual audit (of records required to be retained) immediately upon request from the DMV or the DMV’s representative.

3.Requester understands that failure to respond timely to an audit report with findings, may result in inactivation/ cancellation of the Requester code.

A Public Service Agency

COMMERCIAL REQUESTER ACCOUNT

BRANCH LOCATION REQUESTOR CODE(S) APPLICATION	Page		of
See Instructions on Reverse

NAME OF BUSINESS

REQUESTER CODE(S) (IF ISSUED)

ACCOUNT NUMBER (IF ISSUED)

CORPORATION OR OCCUPATIONAL LICENSE NUMBER OF BRANCH

REQUESTER CODE ACCESS

Same as Main Office Basic record only

DMV USE ONLY

Requester Code(s)

CONTACT PERSON NAME/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS)

E-MAIL ADDRESS

DAYTIME TELEPHONE NUMBER

()

CONTACT PERSON/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS)

E-MAIL ADDRESS

DAYTIME TELEPHONE NUMBER

()

CONTACT PERSON/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS)

E-MAIL ADDRESS

DAYTIME TELEPHONE NUMBER

()

PRINTED NAME

SIGNATURE

DATE

DATE

SIGNATURE OF DEALER OR MANUFACTURER

X