Form Mv 436A PDF Details

The MV-436A form serves as a crucial document within Pennsylvania's vehicle management system, particularly focusing on the ordering of inspection stickers and relevant inserts. Designed for use by authorized vehicle inspection stations, the form is structured to streamline the process of requesting safety and emissions stickers, alongside special inserts such as those for exempted or waived vehicles and temporary tags. Issued by the Pennsylvania Department of Transportation (PennDOT), it requires detailed information, including the station's name, number, address, and contact details. Additionally, the form allows for the order of replacement registration plate cards through Form MV-46, indicating a comprehensive approach to vehicle documentation. The form underscores a no-charge policy for the stickers and inserts, albeit with a shipping and handling fee associated with emissions stickers, and specifies charges for safety stickers, elucidating the financial aspects involved. Detailed instructions on order quantities, represented in multiples of ten, suggest an emphasis on bulk processing. With sections also dedicated to payment and verification procedures, the form embodies a meticulous framework designed to facilitate efficient transactional operations between vehicle inspection stations and PennDOT, thereby ensuring vehicles meet Pennsylvania's safety and emissions standards.

QuestionAnswer
Form NameForm Mv 436A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesOct, Pennsylvania, Feb, Sept

Form Preview Example

MV-436A (7-21)

www.dmv.pa.gov

INSPECTION STICKER AND INSERT ORDER FORM

Please make check/money order payable to: Commonwealth of Pennsylvania

For Department Use Only

Bureau of Motor Vehicles • Sticker Processing Unit • P.O. Box 68697 • Harrisburg, PA 17106-8697

 

A

Station Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Station Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Station Street Address (P.O. Box number may be used in addition to the actual address, but cannot be used as the only address.)

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

City

 

 

 

 

 

 

 

 

State

Zip Code

 

 

E-Mail Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B

INSERTS - NO CHARGE - Inserts should be ordered in conjunction with sticker orders. Quantities may be adjusted at the discretion of PennDOT.

 

 

 

Type

 

 

 

 

 

 

Months Needed

 

 

 

 

 

 

 

 

 

Ordering Requirements

 

 

 

 

Jan

Feb

Mar

 

Apr

May

June

July

Aug

 

Sept

Oct

 

Nov

Dec

 

 

 

 

 

 

 

 

 

 

 

 

 

Safety

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Place number of packs

 

 

 

Inserts

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

desired in spaces to left.

 

 

 

Emissions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Each pack contains 50

 

 

 

Inserts

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

inserts.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

SPECIAL INSERTS - NO CHARGE - Please order in conjunction with stickers.

 

 

 

 

 

 

 

 

 

 

 

Type

 

 

 

 

Quantity

 

 

 

 

 

 

 

 

Ordering Requirements

 

 

 

 

 

E/Exempt Inserts

 

 

 

 

Order in multiples of 10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

W/Waiver Inserts

 

 

 

 

Order in multiples of 10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T-Dot Inserts (TEMP)

 

 

 

 

Order in multiples of 10.

 

 

 

 

 

 

 

 

 

D

 

REPLACEMENT OF ILLEGIBLE

REGISTRATION

PLATE CARDS - Please order in conjunction with stickers.

 

 

 

 

Type

 

Quantity

 

 

 

 

 

 

 

 

Ordering Requirements

 

 

 

 

 

Form MV-46

 

 

 

 

 

 

 

Order in multiples of 10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

EMISSIONS STICKERS - NO CHARGE - Shipping and handling charge applies.

 

 

 

 

 

 

Type

 

Quantity

 

 

 

 

 

 

 

Ordering Requirements

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Emissions Stickers (IM)

 

 

 

 

Order in multiples of 10.

 

 

 

 

 

 

 

 

 

 

 

Minimum order of 10 stickers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

SAFETY STICKERS - CHARGE - Shipping and handling charge applies.

 

 

 

 

 

 

 

 

 

 

 

Type

 

 

 

 

Quantity

 

 

 

Ordering Requirements

 

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annual Inside (AI)

 

 

 

 

Order in multiples of 10 ($9 each).

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

Annual Inspection: Passenger vehicles, trucks,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

emergency vehicles, and certain vans.

 

 

 

 

 

 

Annual Outside (AO)

 

 

 

 

Order in multiples of 10 ($9 each).

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

Motorcycles and all trailers.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Semi-Annual Inside (SI)

 

 

 

 

Order in multiples of 10 ($7 each).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Semi-Annual: School buses, certain vehicles

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

under contract with schools, mass transit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

vehicles, and certain vans and farm vehicles.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G

SIGNATURE - As listed on the current Form MV-500.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Authorized Signature

 

 

 

 

 

 

 

Operator’s #

 

 

 

 

 

State

Total Amount for

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stickers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Name as Above

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

Minus Credit

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATTENTION - Sticker orders should be verified against the receipt. Discrepancies

Subtotal

 

$

 

 

 

should be reported immediately by calling PennDOT at 717-705-2182. Please allow

 

 

 

 

 

 

Shipping and

 

 

 

 

14 days for delivery.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$ 5.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Handling Charge

 

 

 

Please make check/money order payable to the Commonwealth of Pennsylvania and

 

 

 

 

 

Total Amount Due -

$

 

 

 

return to: PennDOT, Bureau of Motor Vehicles, Sticker Processing Unit, P.O. Box

Stickers/Postage

 

 

 

 

68697, Harrisburg, PA 17106-8697.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Include the essential data in the Type, Form MV, Quantity, Ordering Requirements, Order in multiples of, E EMISSIONS STICKERS NO CHARGE, Type, Quantity, Ordering Requirements, Emissions Stickers IM Minimum, Order in multiples of, F SAFETY STICKERS CHARGE, Type, Quantity, and Ordering Requirements segment.

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