Commercial Requester Account Form PDF Details

Applying for a Commercial Requester Account with the California Department of Motor Vehicles (DMV) requires a comprehensive understanding of the instructions and form nuances to avoid processing delays. This application is designated for entities or individuals, known as "End Users," who seek access to Motor Vehicle Records (MVRs) for various commercial purposes. Notably, this also encompasses electrical corporations and their authorized agents seeking residence address information for electric vehicle registers. The DMV emphasizes completeness in application submissions and mandates adherence to specific guidelines for submitting renewal or change applications. Each section of the application form must be completed accurately, including business identification details, type of application, and the proposed permissible uses of the DMV records. Moreover, applicants are advised to be aware of additional requirements if requesting access to confidential residence address information, with clear stipulations on maintaining compliance with federal and state laws to avoid potential legal repercussions. The instructions also outline provisions for service providers, emphasizing the importance of understanding the different methods for accessing DMV records and ensuring all contractual agreements are submitted and maintained as part of the application process. Through careful review and adherence to these instructions, applicants can facilitate a smoother application process for obtaining a Commercial Requester Account.

QuestionAnswer
Form NameCommercial Requester Account Form
Form Length14 pages
Fillable?No
Fillable fields0
Avg. time to fill out3 min 30 sec
Other namesdmv inf your, ca dmv account, california requester account application, dmv inf 1133

Form Preview Example

STATE OF CALIFORNIA

DEPARTMENT OF MOTOR VEHICLES®

COMMERCIAL REQUESTER ACCOUNT

INSTRUCTIONS/APPLICATION

A Public Service Agency

Disclaimer

The information collected on the attached forms is public record and

open to inspection by the public, unless prohibited by statute.

INF 1133 (REV. 12/2011) WWW

Instructions for Completing the Commercial Requester Account (CRA) Application

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-

Page 1

Instructions for Completing the Commercial Requester Account (CRA) Application

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.

Page 2

Instructions for Completing the Commercial Requester Account (CRA) Application

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

Page 3

Instructions for Completing tcieer Account AApplic

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.)

IMPORTANT

TO AVOID PROCESSING DELAYS, PLEASE READ ALL INSTRUCTIONS PRIOR TO COMPLETING FORM.

SECTION A. BUSINESS INFORMATION

1. BUSINESS NAME

 

2. DAYTIME TELEPHONE NUMBER

 

 

(

)

 

 

 

3. DBA (FICTITIOUS BUSINESS NAME)

4. INTERNET WEBSITE ADDRESS (IF NONE, SO STATE)

5. FAX NUMBER

 

 

 

6. CONTACT PERSON NAME/TITLE (INDIVIDUAL RESPONSIBLE FOR THE ACCOUNT)

7. E-MAIL ADDRESS

8. DAYTIME TELEPHONE NUMBER

 

 

(

)

 

 

 

 

9. STREET ADDRESS (PHYSICAL LOCATION REQUIRED)

CITY

STATE

ZIP CODE

 

 

 

 

10. MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)

CITY

STATE

ZIP CODE

SECTION B. BUSINESS IDENTIFICATION

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

Number:

3.OTHER (PLEASE IDENTIFY)

STATE OF ISSUANCE

SECTION C. BUSINESS TYPE

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)

SECTION D. PROFESSIONAL/OCCUPATIONAL LICENSE INFORMATION

1. PROFESSIONAL OR OCCUPATIONAL LICENSEE NAME

2. ISSUING AGENCY NAME A. LICENSE NUMBER B. EXPIRATION DATE (MONTH/YEAR)

SECTION E. COMMERCIAL REQUESTER ACCOUNT HISTORY AND USE

1. Has anyone directly affiliated with any party identified in Section A:

 

 

a. previously applied for, had, or have a Commercial Requester Account?

Yes

No

If yes, print Business Name and/or DBA ________________________________________________ and

Agreement/Account or Requester Code # ________________________________________________

b. been subject to a DMV administrative action?

Yes

No

If yes, attach a separate sheet that includes the type of action, the name of the person and/or business, the reason and date of

incident.

2. Has anyone having access ever been convicted of any crime for a violent act, stalking, computer fraud, or for unauthorized

disclosure, access or distribution of information?

Yes

No

If yes, attach a separate sheet that includes the name of the person, the specific code violation, conviction date, court, and action taken.

3. a. I will be using the information for my own business use as approved by the department.

b. I will be using the information to perform a legitimate business service on behalf of another CRA applicant (i.e., pass through/reformat, other contracted services) as approved by the department. Access authority will be based on the other CRA applicant

INF 1106 (REV. 11/2006)

SECTION F. RECORD ACCESS METHOD

1. Will you obtain information through a DMV approved Service Provider/Vendor?

Yes

No

If “Yes”, is the access method on-line? (Instant response)

Yes

No

If “No”, please provide a mailing address where you would like your invoices sent. If address is the same as the mailing address identified in Section A, please state “Same”: _________________________________________________________________

____________________________________________________________________________________________________

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

 

SECTION G. PERMISSIBLE USE(S)/PURPOSE - Each permissible use must be listed separately.

 

For DMV Use Only

 

 

1. IDENTIFY PROPOSED USE

 

 

 

 

 

 

 

Proposed Use Approved

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

Requester Code Issued

 

 

Type:

VR

DL

OL

FR

Residence address requested:

Yes

No

 

 

 

 

# ______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. IDENTIFY PROPOSED USE

 

 

 

 

 

 

 

Proposed Use Approved

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

Requester Code Issued

 

 

Type:

VR

DL

OL

FR

Residence address requested:

Yes

No

 

 

 

 

# ______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. IDENTIFY PROPOSED USE

 

 

 

 

 

 

 

Proposed Use Approved

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

Requester Code Issued

 

 

Type:

VR

DL

OL

FR

Residence address requested:

Yes

No

 

 

 

 

# ______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. IDENTIFY PROPOSED USE

 

 

 

 

 

 

 

Proposed Use Approved

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

Requester Code Issued

 

 

Type:

VR

DL

OL

FR

Residence address requested:

Yes

No

 

 

 

 

# ______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION H. ACKNOWLEDGEMENT AND CERTIFICATION STATEMENT

I hereby acknowledge that I have received, read, and agree to the Commercial Requester Account Terms and Conditions (INF 1230).

I understand that the use, or unauthorized disclosure, of departmental information for a purpose other than that for which this applicant applied, and was approved by the Department, is prohibited and subject to criminal prosecution, including fines and imprisonment. (California Vehicle Code Section 1808.45) I further understand that obtaining departmental information under false representations, the distribution of restricted information, or use of information for a purpose not specified by this applicant and approved by the Department, may result in suspension/revocation of applicant’s access privileges and civil penalties up to $100,000. (California Vehicle Code Section 1808.46)

I certify (or declare) under penalty of perjury under of the laws of the State of California that the foregoing is true and correct. I further consent to receive service of process pursuant to the provisions of California Vehicle Code Section 1808.21(c).

EXECUTED AT

CITY

COUNTY

ON (DATE)

 

 

 

 

 

SIGNATURE OF AUTHORIZED REPRESENTATIVE

 

 

 

X

 

 

 

 

PRINTED NAME

 

TITLE

DAYTIME TELEPHONE NUMBER

 

 

 

(

)

 

 

 

 

SECTION I. DMV APPROVAL

 

 

 

STATE OF CALIFORNIA

 

 

 

Department of Motor Vehicles

 

 

 

 

 

 

 

SIGNATURE (DMV REPRESENTATIVE)

 

DATE

 

X

 

 

 

 

 

 

 

 

 

IMPORTANT

Information provided on this form is Public Record, unless expressed otherwise in statute.

Any confidential information will not be released to the general public.

Applicant must retain a copy of the application for their records.

Mail To: DMV, Account Processing Unit

MS-H221, P.O. Box 944231,

Sacramento, CA 94244-2310

INF 1106 (REV. 11/2006)

A Public Service Agency

INFORMATION SERVICES BRANCH

COMMERCIAL REQUESTER ACCOUNT

TERMS AND CONDITIONS

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

INF 1230 (NEW 3/2004)

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.

INF 1230 (NEW 3/2004)

A Public Service Agency

COMMERCIAL REQUESTER ACCOUNT

BRANCH LOCATION REQUESTOR CODE(S) APPLICATION

Page

 

of

 

 

 

See Instructions on Reverse

 

 

 

Billing Address: Check one box only

Main Office

Branch Location

 

 

 

 

 

 

SECTION A: Main Office

 

 

NAME OF BUSINESS

REQUESTER CODE(S) (IF ISSUED)

ACCOUNT NUMBER (IF ISSUED)

SECTION B: Branch Locations

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

()

STREET ADDRESS (PHYSICAL LOCATION REQUIRED)

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV)

 

 

STREET

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

CORPORATION OR OCCUPATIONAL LICENSE NUMBER OF BRANCH

REQUESTER CODE ACCESS

 

DMV USE ONLY

 

 

Same as Main Office

Requester Code(s)

 

 

 

 

Basic record only

 

 

 

 

 

 

 

 

CONTACT PERSON/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS)

 

E-MAIL ADDRESS

DAYTIME TELEPHONE NUMBER

 

 

 

(

)

 

 

 

 

 

 

 

STREET ADDRESS (PHYSICAL LOCATION REQUIRED)

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)

 

CITY

 

STATE

ZIP CODE

 

 

 

RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV)

 

 

STREET

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

CORPORATION OR OCCUPATIONAL LICENSE NUMBER OF BRANCH

REQUESTER CODE ACCESS

 

DMV USE ONLY

 

 

Same as Main Office

Requester Code(s)

 

 

 

 

Basic record only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT PERSON/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS)

E-MAIL ADDRESS

DAYTIME TELEPHONE NUMBER

()

STREET ADDRESS (PHYSICAL LOCATION REQUIRED)

CITY

STATE

ZIP CODE

 

 

 

 

 

MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)

CITY

STATE

ZIP CODE

 

 

 

 

RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV)

 

STREET

CITY

STATE

ZIP CODE

 

 

 

 

 

CORPORATION OR OCCUPATIONAL LICENSE NUMBER OF BRANCH

REQUESTER CODE ACCESS

 

DMV USE ONLY

 

 

Same as Main Office

Requester Code(s)

 

 

 

Basic record only

 

 

 

 

 

 

 

 

 

 

 

CONTACT PERSON/TITLE (INDIVIDUAL RESPONSIBLE FOR ACCESS)

E-MAIL ADDRESS

DAYTIME TELEPHONE NUMBER

()

STREET ADDRESS (PHYSICAL LOCATION REQUIRED)

CITY

STATE

ZIP CODE

 

 

 

 

MAILING ADDRESS (IF SAME AS PHYSICAL LOCATION, SO STATE)

CITY

STATE

ZIP CODE

 

 

 

RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV)

 

 

STREET

CITY

STATE

ZIP CODE

 

 

 

 

COMPLETED BY (NAME AND TITLE)

 

DATE

 

x

IMPORTANT

Information provided on this form is Public Record. Information that is confidential according to statute will be masked prior to release.

Applicant must retain a copy of the application for their records.

INF 1106BL (REV. 3/2004)

INSTRUCTIONS FOR COMPLETING THE COMMERCIAL REQUESTER ACCOUNT

BRANCH LOCATION REQUESTOR CODE(S) APPLICATION

IMPORTANT

KEEP COPIES OF ALL FORMS FOR YOUR RECORDS PRIOR TO SUBMITTING THEM TO THE DMV.

COPIES WILL NOT BE RETURNED

WHAT IS A BRANCH LOCATION?

For purposes of completing this application, a “Branch Location” is defined as “an offshoot, lateral extension, or division of an institution with a separate physical location.” In order to be enrolled as a Branch Location, the branch must be operating under the same corporate number or Occupational License as the account holder. If separate corporation numbers or Occupational License numbers are indicated, they must complete an application for a separate Commercial Requester Account (CRA).

FEE:

There are no additional application fees for branch locations.

BILLING INFORMATION:

Main Office or Branch Location Billing Information – Each branch location will be issued a separate requester code. The monthly billing invoice is automatically mailed to the branch location (when information is received directly from the DMV) unless you indicate that you want the billing invoice mailed to the main office. Check the appropriate box where you want billing invoices mailed.

Note: This only applies if information is being purchased directly from the DMV.

SECTION A

Complete as many copies of form INF 1106BL as needed but be sure to provide the Name of the Business on each form and number them properly (i.e., 1 of 22). In addition, include the Requester Code Number(s) and Account Number(s), if already issued, of the account holder.

SECTION B

Complete for each branch location as follows:

Corporation or Occupational License # of Branch – Provide the Corporation or Occupational License # under which the branch location is operating. Please remember, if the branch location has a separate Corporation or Occupational License, they must complete an application for a separate CRA.

Requester Code Access – If the main office and specified branch locations are to have the same type of access, mark “Same as Main Office.” If the Main Office is authorized to and is receiving residence address information and the branch locations are to be restricted to basic record information only (i.e., no residence addresses), mark “Basic record only”.

DMV USE ONLY – Leave Blank.

Contact Person Name/Title, E-Mail Address, Daytime Phone – Please provide the name, e-mail address (if applicable) and daytime phone number of the individual who will be responsible for the branch location’s access.

Street Address – Please provide the physical address of the branch location including number, street, city, state and zip.

Mailing Address – Please provide the mailing address of the branch location where you would like DMV information mailed. If same as street address, state “Same”.

Record Storage Address – Please provide the physical location where records will be maintained for on-site inspection, review or audit by DMV or designated representative.

INF 1106BL (REV. 3/2004)

A Public Service Agency

INFORMATION SERVICES BRANCH

INFORMATION SECURITY STATEMENT

To be completed by any individual having access to DMV record information. Annual re-certification is required. (See reverse)

By signing this form, the undersigned represents that he/she has read and understands the same, agrees to its contents and realizes the penalties for non-compliance to its terms.

The California Department of Motor Vehicles (CA DMV) collects information from the public to administer the various programs for which it has responsibility. CA DMV is committed to protect this information from unauthorized access, use, or disclosure. The following have been adopted to address commercial and governmental users responsibilities for handling and protecting information obtained from the CA DMV. I understand the following are my responsibilities:

1.I may access information only when necessary to accomplish the responsibilities of my employment. I may not access or use information from the CA DMV for personal reasons. (Examples of inappropriate access or misuse of CA DMV information include, but are not limited to: making personal inquiries or processing transactions on my own records or those of my friends or relatives; accessing information about another person, including locating their residence address, for any reason that is not related to my job responsibilities.)

2.I may disclose CA DMV information only to individuals who have been authorized to receive it through the appropriate procedures as regulated by CA DMV. Requesters of information must complete the appropriate forms, submit them to CA DMV as specified, and pay all applicable fees. In the case of confidential or personal information, a proper accounting of all disclosures must be made and the subject must be notified in accordance with statute and CA DMV directives. (Examples of unauthorized disclosures include, but are not limited to: telling someone the address of another person when it is not an authorized disclosure or part of my job responsibilities.)

3.To keep the requester code and/or password confidential, I must take reasonable precautions to maintain the secrecy of any requester code and/or my password. Reasonable precautions include, but are not limited to, not telling or allowing others to view my password or requester code; securing my terminal with a locking device if one has been provided; storing user documentation to sensitive programs in a secure place; to destroy CA DMV information in a manner that it cannot be reproduced or identified in any physical or electronic form; and reporting any suspicious circumstances or unauthorized individuals I have observed in the work area to my supervisor, if applicable.

4.To promptly notify your manager or supervisor of any indication of misuse or unauthorized disclosure of information obtained from CA DMV.

Federal law states:

“Any person who knowingly obtains, discloses, or uses personal information from a motor vehicle record for a purpose not permitted under the Driver’s Privacy Protection Act (Title 18 of the United States Code, Section 2721 – 2725), shall be liable to the individual to whom the information pertains, who may bring a civil action in a United States district court.

I certify under penalty of perjury, under the laws of the State of California, that I have read and understand the security policies stated above. I understand that failure to comply with these policies and regulations may result in disciplinary action in accordance with state and federal laws and regulations, and/or civil or criminal prosecution in accordance with applicable statutes. I further understand that I may undergo disciplinary action from my employer up to and including termination from employment.

EXECUTED AT

CITY

COUNTY

STATE

ZIP CODE

 

 

 

 

 

SIGNATURE

 

 

DATE

 

X

 

 

 

 

 

 

 

 

 

PRINTED NAME OF SIGNATORY

 

 

 

 

 

 

 

 

 

GOVERNMENT OR COMMERCIAL ENTITY REPRESENTATIVE

 

NAME OF GOVERNMENT OR COMMERCIAL ENTITY

 

 

 

 

 

 

 

 

 

 

 

 

This form must be completed upon presentation and re-certified annually and RETAINED AT THE WORKSITE of the Requester Account Holder with a current list of those authorized direct or incidental record access for the life of the account and for two years following the deactivation or termination of the account. This completed form and list must be made available upon request to DMV audit staff.

INF 1128 (REV. 9/2006)

ANNUAL RE-CERTIFICATION

I have read and understand the security policies stated within the Information Security Statement. I understand that failure to comply with these policies may result in disciplinary action in accordance with Section 19572 of the government Code, federal laws and regulations, and/or civil or criminal prosecution in accordance with applicable statutes.

PRINTED NAME

SIGNATURE

DATE

INF 1128 (REV. 9/2006)

A Public Service Agency

INFORMATION SERVICES

CERTIFICATION OF AGENCY

PLEASE CHECK THE APPROPRIATE BOX BELOW:

My business is a vehicle dealership licensed to do business in the state of California. My business is a vehicle manufacturer licensed to do business in the state of California.

PLEASE PRINT THE FOLLOWING INFORMATION REGARDING YOUR OWN BUSINESS:

NAME

ADDRESS

STREET

CITY

STATE

ZIP CODE

 

 

 

DEALER/MANUFACTURER LICENSE NUMBER

DAYTIME TELEPHONE NUMBER

 

 

 

(

)

 

I hereby certify, under penalty of perjury, that the party specified below is authorized to act as my agent for the purpose of obtaining information from the Department of Motor Vehicles pursuant to Vehicle Code Section 1808.23.

In making this authorization, I agree to:

Hold the Department harmless from any monetary loss to the Department by reason of the use of informa- tion obtained from the Department by this agent; AND

Pay to the Department, its officers, and any other person(s) all civil damages occasioned to the Department or such persons by reason of the following acts or omissions by this agent:

(a)obtaining information from the Department by means of false or misleading representations, OR

(b)selling, giving, or otherwise furnishing any information obtained from Department records to any third party not specifically authorized and approved by the Department.

PLEASE PRINT THE FOLLOWING INFORMATION REGARDING THE AGENT YOU ARE AUTHORIZING

NAME

ADDRESS

STREET

CITY

STATE

ZIP CODE

 

 

 

DRIVER LICENSE NUMBER

TELEPHONE NUMBER

 

 

 

(

)

 

I certify, under penalty of perjury, that the foregoing is true and correct.

 

 

 

 

 

 

EXECUTED AT

CITY

 

COUNTY

STATE

DATE

SIGNATURE OF DEALER OR MANUFACTURER

X

INF 1184 (NEW 2/91)

How to Edit Commercial Requester Account Form Online for Free

When working in the online tool for PDF editing by FormsPal, you are able to complete or change california requester account application here and now. In order to make our editor better and less complicated to utilize, we constantly work on new features, with our users' suggestions in mind. Getting underway is effortless! All you need to do is stick to the next basic steps directly below:

Step 1: Open the PDF form inside our tool by pressing the "Get Form Button" in the top section of this page.

Step 2: With our state-of-the-art PDF editor, you'll be able to accomplish more than just fill out blank form fields. Express yourself and make your docs appear professional with customized textual content put in, or adjust the original input to perfection - all that comes along with the capability to add any kind of graphics and sign the PDF off.

To be able to finalize this document, make sure you enter the right information in each and every blank:

1. The california requester account application will require certain details to be entered. Be sure the subsequent fields are completed:

Best ways to prepare inf 1133 application stage 1

2. Soon after finishing the previous section, go on to the subsequent step and fill in all required details in all these blank fields - The following documentsitems MUST, Commercial Requester Account, ORIGINAL APPLICATION OR RENEWAL FEE, Make check or money order payable, Account not requesting andor, residence address information, Account authorized to and, residence address information, NOTE of the application fees is, No charge for changing contact, proposed use etc, NOTE Change of ownership will, ONLY IF APPLICABLE, Commercial Requester Account, and Commercial Requester Account Terms.

inf 1133 application conclusion process shown (portion 2)

3. The following step is all about Commercial Requester Account, Branch Location Requester Codes, NOTE The Branch Location Requester, Sacramento CA, If you need additional assistance, Please dont forget that if you, and Page - type in all of these blank fields.

Commercial Requester Account, Branch Location Requester Codes, and If you need additional assistance in inf 1133 application

4. The next paragraph needs your attention in the subsequent parts: A Public Service Agency, Check One Only, COMMERCIAL REQUESTER ACCOUNT, APPLICATION, Account Number, CA IDDATE, EXPIRES, Original Application All sections, Requester Codes REQUIRED, Renewal All sections must be, TO AVOID PROCESSING DELAYS PLEASE, IMPORTANT, SECTION A BUSINESS INFORMATION, BUSINESS NAME, and DBA FICTITIOUS BUSINESS NAME. Be sure to give all of the requested information to move further.

Guidelines on how to prepare inf 1133 application portion 4

5. To conclude your document, the final area has a couple of extra fields. Completing SECTION C BUSINESS TYPE, AttorneyLaw Office Auto Auction, Independent Institution of Higher, PIDetective Agency Process Server, SECTION D PROFESSIONALOCCUPATIONAL, PROFESSIONAL OR OCCUPATIONAL, ISSUING AGENCY NAME, SECTION E COMMERCIAL REQUESTER, Has anyone directly affiliated, A LICENSE NUMBER, B EXPIRATION DATE MONTHYEAR, Yes, If yes print Business Name andor, AgreementAccount or Requester Code, and b been subject to a DMV is going to finalize everything and you're going to be done in a snap!

inf 1133 application conclusion process explained (stage 5)

Always be very attentive when completing A LICENSE NUMBER and SECTION C BUSINESS TYPE, since this is the part where most users make a few mistakes.

Step 3: As soon as you've looked over the information provided, click "Done" to finalize your form at FormsPal. Go for a free trial account at FormsPal and acquire direct access to california requester account application - download, email, or edit in your personal account. At FormsPal.com, we aim to be sure that your details are maintained private.