OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES OHIO TEMPORARY TAG/STICKER DEALER ORDER FORM IS ORDER TO BE: MAILED PICKED UP Order on-line using an electronic check. Visit our Web site at: LOCATION FOR PICK UP: 1970 W. BROAD ST. COLUMBUS, OH PLEASE TYPE OR PRINT LEGIBLY NAME PERMIT NUMBER BUSINESS ADDRESS DEALER TELEPHONE NUMBER CITY STATE QUANTITY NON-WE DEALER AMOUNT ZIP CODE WE DEALER AMOUNT REGULAR PLATE SIZE TEMPORARY TAGS @ $18.50 @ $18.50 @ $15.00 APV & OFF HIGHWAY MOTORCYCLE TEMPORARY STICKERS @ $5.50 BMV USE ONLY @ $15.00 MOTORCYCLE SIZE TEMPORARY TAGS TOTAL FEE @ $5.50 Make Checks Payable to: OHIO TREASURER JOSH MANDEL Dealers who report Temporary Tags electronically may purchase tags at $15.00 each and sell them to customers for $18.50. Dealers may keep the $3.50 difference. You must sign up as a web enabled (WE) dealer prior to purchasing the tags at $15.00. Log on to our Web site at www.OhioAutoDealers.com, or call (614) 752-7880 for more details. Customers wishing to pick-up temporary tags may fax their orders in advance. Please fax order for next day pick-up. Payment is due at the time of pick up. All Fax-n-GO orders not picked up within two (2) business days will be cancelled. A valid photo ID must be presented when picking up temporary tag orders. DATE AUTHORIZED DEALER SIGNATURE X Mail to: Ohio Bureau of Motor Vehicles Attn: Temporary Tag Unit P.O. Box 16521 Columbus OH 43216-6521 BMV 4381 1/11 Want to be a WE Dealer? Purchase tags at $15.00 and sell them for up to $18.50. Visit our Web site, www.ohioautodealers.com or call 614-752-7880 Fax-n-GO orders: 1970 W. Broad St. Fax: 614-752-1363 For hours of operation please refer to: www.bmv.ohio.gov For details select: Branch Location Shipley Building: www.OhioAutoDealers.com Dept. #403 American LegalNet, Inc. www.FormsWorkFlow.com