Form MV-436A PDF Details

Safety stickers and special inserts are ordered in multiples of 10, and emissions stickers have a minimum order of 10 stickers.

Inserts: each pack contains 50 inserts, and inserts should be ordered in conjunction with sticker orders.

Signature: as listed on the current Form MV-500.

Station address: a P.O. Box number may be used in addition to the actual address, but cannot be used as the only address.

Discrepancies: sticker orders should be verified against the receipt, and discrepancies reported immediately by calling PennDOT at 717-705-2182.

Question	Answer
Form Name	Form MV-436A
Form Length	1 page
Fillable?	Yes
Fillable fields	54
Avg. time to fill out	9 min
Edition	8-25
Issuing agency	PennDOT, Bureau of Motor Vehicles
Where to send	PennDOT, Bureau of Motor Vehicles, Sticker Processing Unit, P.O. Box 68697, Harrisburg, PA 17106-8697
Delivery	Please allow 14 days for delivery
Matches the agency's file	Yes, checked October 1, 2026
Other names	MV-436A, MV436A, MV 436A, Form MV-436A, PA Inspection Sticker Order Form, Inspection Sticker and Insert Order Form
Official source	Form MV-436A (Rev 8-25), PennDOT, Bureau of Motor Vehicles

How to Fill Out Form MV-436A

Form MV-436A at a glance

What it is: This is Form MV-436A, the Inspection Sticker and Insert Order Form.

Who signs: Under G, SIGNATURE: As listed on the current Form MV-500.

A filled-in Form MV-436A example: a station orders inserts and stickers

Form MV-436A example filled out, example: a station orders inserts and stickers — Alex Sample signs for Sample Auto Inspection, a made-up station, and places one order. It asks for 2 packs of Safety Inserts for January and 2 for July and 1 pack of Emissions Inserts for January; 10 E/Exempt Inserts and no W/Waiver or T-Dot Inserts, so those two lines stay blank; 10 of Form MV-46I; 10 Emissions Stickers (IM); 20 Annual Inside (AI), 10 Annual Outside (AO) and 10 Semi-Annual Inside (SI) stickers. The example assumes: Alex Sample is the signer listed on the station's current Form MV-500; each Amount is the quantity times the price printed on the form (12 dollars each for AI and AO, 10 dollars each for SI), so the three Amounts are 240.00, 120.00 and 100.00; Total Amount for Stickers is the sum of those three Amounts, 460.00, because the inserts, plate cards and emissions stickers are no charge; the station has a credit balance of 40.00, and the Subtotal is the Total Amount for Stickers minus that credit, 420.00; and the Total Amount Due is that Subtotal plus the printed Shipping and Handling Charge of 5.00, 425.00. This file has no fillable box on the Subtotal line, so the example leaves it out and a real order writes 420.00 there; it also has none on the Authorized Signature line, so that line is signed by hand and left empty here. Every name, number, address and amount in the example is made up.

How to fill out Form MV-436A, box by box

The station (box A)

Under A, fill in the Station Name and the Station Number.

Fill in the Station Street Address. A P.O. Box number may be used in addition to the actual address, but cannot be used as the only address. Then fill in the Telephone Number.

Fill in the City, State and Zip Code, and the E-Mail Address.

Safety and emissions inserts, by month (box B)

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

For Safety Inserts and Emissions Inserts, place the number of packs desired in the spaces for each of the Months Needed. Each pack contains 50 inserts.

Special inserts and replacement plate cards (boxes C and D)

Under C, SPECIAL INSERTS - NO CHARGE, and under D, REPLACEMENT OF ILLEGIBLE REGISTRATION PLATE CARDS: Please order in conjunction with stickers. For E/Exempt Inserts, W/Waiver Inserts, T-Dot Inserts (TEMP) and Form MV-46I, fill in the Quantity, in multiples of 10.

Stickers: emissions (box E) and safety (box F)

Under E, EMISSIONS STICKERS - NO CHARGE: Shipping and handling charge applies. For Emissions Stickers (IM), fill in the Quantity, in multiples of 10: Minimum order of 10 stickers.

Under F, SAFETY STICKERS - CHARGE: For each Type, fill in the Quantity and the Amount.

Annual Inside (AI): Order in multiples of 10 ($12 each) (checked October 23, 2026). Annual Inspection: Passenger vehicles, trucks, emergency vehicles, and certain vans.

Annual Outside (AO), in multiples of 10 ($12 each) (checked October 23, 2026): Motorcycles and all trailers.

Semi-Annual Inside (SI): Order in multiples of 10 ($10 each) (checked October 23, 2026). Semi-Annual: School buses, certain vehicles under contract with schools, mass transit vehicles, and certain vans and farm vehicles.

Signature, totals and shipping (box G)

Under G, SIGNATURE: As listed on the current Form MV-500.

Fill in the Authorized Signature, the Operator’s # and the State.

Fill in the Date.

Fill in Total Amount for Stickers and Minus Credit Balance, then Subtotal.

Shipping and Handling Charge: $5.00 (checked October 23, 2026).

The last line is Total Amount Due - Stickers/Postage.

More rules for Form MV-436A

Sticker orders should be verified against the receipt. Discrepancies should be reported immediately by calling PennDOT at 717-705-2182. Please allow 14 days for delivery.

Common questions about Form MV-436A

Where do I file it?

Please make check/money order payable to the Commonwealth of Pennsylvania and return to: PennDOT, Bureau of Motor Vehicles, Sticker Processing Unit, P.O. Box 68697, Harrisburg, PA 17106-8697.

Sources

[1] Form MV-436A (8-25), Inspection Sticker and Insert Order Form, Pennsylvania Department of Transportation (PennDOT) (the Official source link on this page).

MV-436A: Pennsylvania Inspection Sticker and Insert Order Form