Inf 1106 Form PDF Details

The INF 1106 form serves as a crucial document for businesses seeking to establish a Commercial Requester Account with the California Department of Motor Vehicles (DMV). It caters to various entities including attorneys, law offices, auto dealers, insurance companies, and more, who require access to DMV records for legitimate business purposes. The form is comprehensive and requires applicants to provide detailed business information, including but not limited to the business name, contact information, physical and mailing addresses, and details regarding the type of business. Applicants must also disclose any previous applications or administrative actions related to DMV accounts, criminal convictions among those with access, and the intended use of the requested information. Moreover, the form emphasizes the necessity of acknowledging and certifying compliance with DMV terms and conditions, highlighting the legal implications of misuse of information. Through sections ranging from business identification to permissible uses and purposes, the INF 1106 form thoroughly assesses the applicant's eligibility for a Commercial Requester Account, ensuring that access is granted only for approved purposes, thereby safeguarding personal information handled by the DMV. It also outlines the preferred method of record access, whether through a DMV-approved service provider or directly, further indicating the form’s role in facilitating a structured process for information access, crucial for various commercial operations.

QuestionAnswer
Form NameInf 1106 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform inf 1106, inf 1106 form dmv, inf1106 ca form, requester

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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) WWW

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) WWW

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This PDF will require particular information to be filled out, hence you must take the time to type in exactly what is asked:

1. The requester involves specific information to be entered. Make certain the next fields are complete:

Writing segment 1 of commercial

2. Once your current task is complete, take the next step – fill out all of these fields - FEDERAL EMPLOYER ID OR STATE TAX, CORPORATION LLC LLP LP ID IF, OTHER PLEASE IDENTIFY, SECTION C BUSINESS TYPE, STATE OF ISSUANCE, 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, and B EXPIRATION DATE MONTHYEAR with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

PIDetective Agency Process Server, Has anyone directly affiliated, and SECTION E COMMERCIAL REQUESTER of commercial

3. Through this part, have a look at Has anyone having access ever, disclosure access or distribution, I will be using the information, Yes, a b, and INF REV WWW. Every one of these are required to be completed with utmost accuracy.

The way to fill out commercial stage 3

4. Completing SECTION F RECORD ACCESS METHOD, Will you obtain information, Yes Yes, No No, If Yes is the access method online, Are you interested in other, If yes see instructions for other, Yes, SECTION G PERMISSIBLE USESPURPOSE, For DMV Use Only, IDENTIFY PROPOSED USE, Type, Residence address requested, Yes, and IDENTIFY PROPOSED USE is vital in this next section - ensure to spend some time and fill out every single field!

Guidelines on how to prepare commercial portion 4

Concerning SECTION F RECORD ACCESS METHOD and Type, make sure that you take a second look in this section. Both these are thought to be the most significant fields in the file.

5. This last section to conclude this form is essential. You'll want to fill in the appropriate fields, for instance Type, Residence address requested, Yes, SECTION H ACKNOWLEDGEMENT AND, Requester Code Issued, I hereby acknowledge that I have, I understand that the use or, I certify or declare under penalty, consent to receive service of, EXECUTED AT, CITY, SIGNATURE OF AUTHORIZED, PRINTED NAME, SECTION I DMV APPROVAL, and STATE OF CALIFORNIA, before submitting. If not, it can contribute to an incomplete and probably nonvalid paper!

Step number 5 for filling in commercial

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