Form VSA 10 at a glance
What it is: The License Plate Application, VSA 10, is the form to request souvenir, standard, personalized or special license plates.
Who signs: The owner signs on the OWNER'S SIGNATURE line and enters the DATE (mm/dd/yyyy). For a corporation, an authorized representative must sign.
A filled-in Form VSA 10 example: a scenic plate with two personalized choices
How to fill out Form VSA 10, box by box
Select the type of License Plate you are requesting
Under A, select the type of License Plate you are requesting: License Plate, Disabled Plate, Souvenir Plate, Hearing Impaired Plate or Transfer Existing Plate. Select only one.
Select the License plate you are requesting
Under B, select the License plate you are requesting. Select only one.
STANDARD, DISABLED VETERAN (DV) PLATE, STANDARD PLATE - DV, HERITAGE (Dogwood-Cardinal) and LIGHTHOUSE. A VA Benefit letter or a VSA 54 is required for the DISABLED VETERAN (DV) PLATE and the STANDARD PLATE - DV.
For SCENIC, select one background type: AUTUMN, MOUNTAIN TO SEASHORE or PATRIOT.
For COLLEGE, enter the college with no initials or abbreviations, and its Locality: County or City.
For SPECIAL INTEREST or MILITARY, enter the name with no initials or abbreviations. Organization Name: if the organization has more than one license plate, specify design type.
For CLEAN FUEL, enter the Vehicle Year, Make and Model, and review the Clean Special Fuel License Plates section on page 2 of the application.
For OTHER, enter any License plate not listed. Some plates may require a certification.
Personalized or Souvenir Plate
If you are requesting a personalized or souvenir plate, complete the table. Please review the "Personalized License Plate Policy" on page 2 of this application. You may enter up to four (4) different options for the personalized/souvenir plate; up to 8 characters.
Indicate your choices in order of preference.
The maximum number of characters allowed on standard and scenic license plates is 7 ½. The maximum number of characters allowed on a heritage license plate is 6 ½. Six characters are allowed on all other license plates bearing logos.
License plates with logos may sometimes accommodate an additional ½ space when personalized. A blank space and a dash are the only two characters that are ½ characters. An ampersand is considered a full character. Spaces, dashes, and ampersands cannot be used consecutively.
Hearing Impaired Certification
Under HEARING IMPAIRED CERTIFICATION: "I certify that I am hearing impaired and cannot hear and understand normal speech. I am aware it is unlawful for any person who can hear and understand normal speech to obtain this license plate."
Due to the license plate design, personalization is not allowed for hearing impaired license plates.
Applicant Information
Under APPLICANT INFORMATION, enter the OWNER'S NAME (last) (first) (mi) and the DAYTIME TELEPHONE NUMBER.
If there is a co-owner, enter the CO-OWNER'S NAME (last) (first) (mi) and the DAYTIME TELEPHONE NUMBER.
Enter the CURRENT MAILING ADDRESS, CITY, STATE and ZIP.
Enter the PLATE TYPE, PLATE EXPIRATION DATE and CURRENT PLATE NUMBER.
Enter the VEHICLE IDENTIFICATION NUMBER and VEHICLE TITLE NUMBER.
Insurance Certification
Under INSURANCE CERTIFICATION, enter the NAME OF INSURANCE COMPANY. You certify that this vehicle is insured by a liability policy issued through an insurance company licensed to do business in Virginia and it will remain insured while registered, whether or not it is operated.
Penalties are severe for violation of this requirement.
Failure to comply with Virginia's insurance requirements will result in suspension of your driver's license and vehicle license plates.
Signatures
You further certify and affirm that all information presented in this form is true and correct, that any documents you have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. You make this certification and affirmation under penalty of perjury and you understand that knowingly making a false statement or representation on this form is a criminal violation.
The owner signs on the OWNER'S SIGNATURE line and enters the DATE (mm/dd/yyyy).
If there is a co-owner, the co-owner signs on the CO-OWNER'S SIGNATURE line and enters the DATE (mm/dd/yyyy).
For a corporation, an authorized representative must sign.
More rules for Form VSA 10
Review the "Additional Information Section" on the back of the form.
POWER OF ATTORNEY FOR NON-RESIDENT(S) AND CORPORATION(S) NOT DOMICILED IN VIRGINIA: Pursuant to the provisions of Virginia Code §46.2-601, you appoint the Commissioner of the Department of Motor Vehicles of the Commonwealth of Virginia, to be your true and legal agent upon whom all legal processes against you may be served in any legal proceeding arising from the operation and/or use of any motor vehicle registered in your name(s) in the Commonwealth of Virginia.
If you are renewing early, the special license plate and/or personalized license plate fees will be prorated for the months remaining on your current vehicle registration.
The Department of Motor Vehicles (DMV) will not honor a change of choice or refund after the order has been sent to the manufacturer.
Personalized license plates require special handling; allow up to 60 days for delivery. Plates will be mailed directly to the applicant.
All personalized character combinations are screened by DMV to ensure compliance with DMV's Personalized License Plate Policy. The combination of characters used to personalize a license plate must not violate DMV's Personalized License Plate Policy.
In addition, Virginia Code § 46.2-726 prohibits DMV from issuing to certain applicants any personalized character combination that can be read, interpreted, or understood to be a reference to children.
Clean special-fuel plates do not allow free access to any Express Lanes; vehicles must carry the specified number of passengers and be equipped with an E-ZPass Flex set to "HOV" mode. Otherwise, drivers must pay a toll to access the lanes.
Not all vehicles qualify for the clean special fuel license plate.
Common questions about Form VSA 10
Where do I file it?
Mail the completed form, with the appropriate fees, to Virginia Department of Motor Vehicles, Post Office Box 27412, Richmond, Virginia 23269-0001. Or you may apply online at https://www.dmv.virginia.gov/vehicles/license-plates or at any DMV Customer Service Center or DMV Select office.
Are there fees?
Special license plate fees can be $10, $15, or $25 annually or a one-time $10, $25 or $50 fee based on the plate design, in addition to the registration fees. (checked October 20, 2026) Personalization is an additional $10 annually. (checked October 20, 2026)
Sources
[1] VSA 10 (07/01/2026), License Plate Application, Virginia Department of Motor Vehicles (the Official source link on this page).