EOEEA-DPU

1. Company Information

Name of Person Completing this application:

First Last

Company Name:

Address:

Street Address Address Line 2 City State ZIP Code

Mailing Address, if different from above:

Street Address Address Line 2 City State ZIP Code

Email Address:

Business Office Telephone:

DPU- Issued Certificate Number:

2. Vehicle Information

Registration Number:	Title Number:	Year:	Make:	Motor Type:	Vehicle Identification Number (VIN)	Actions

There are no Entries.

3. Insurance

Each Company must keep on file with the DPU a current Certificate of Insurance. If you have not filed a current proof of insurance, please attach it below or have your agent send proof of coverage to dpu.transportation@mass.gov

Attach proof of insurance here:

Drop files here or

Max. file size: 50 MB.

4. Fees

The fee is $40 per decal. DPU will not issue a permit until fees are paid.

Complete and submit this application first, then go to our Pay Transportation Oversight Division fees page. (opens in new tab) If you move forward to the payment website without submitting this application, any information that you have already entered will be lost.

Submit a check or money order to the address above OR submit a payment online.

Payment Method:

Pay online

Send payment by US Mail

5. Signature

Type Name:(Required)

Title:(Required)