
Page 1 of 2VI-2 (Rev. 9/2017)
Texas Department of Public Safety
Regulatory Services Division
www.dps.texas.gov
VEHICLE INSPECTION
STATION INFORMATION
Station Name
(DBA):
County: Federal / Tax ID # or Social Security Number:
Corporation or Business Name:
Station Website: Station Email Address:
Phone Number: Fax Number:
OWNER #1
Last Name: First Name: Middle Name: Sufx:
Date of Birth: Driver License # DL State: DL Expiration:
Station
Physical
Address
Address:
City: State: ZIP + 4: County:
Station
Mailing
Address
Address:
City: State: ZIP + 4: County:
Business Hours Monday through Friday _____ a.m. to _____ p.m. Saturday _____ a.m. to _____ p.m. Sunday _____ a.m. to _____ p.m.
Business Type: Corporation Partnership Sole Proprietor Government
Change: Name Location Add Owner
For Corporations, I certify that:
My corporate franchise taxes owed to the State of Texas under Tax Code Chapter 171, are current.
The corporation is exempt from, or not subject to, the Texas Franchise Tax.
____________________________________________________________ ______________________________________________________ ___________________
Name of Business Owner (if applicable) Email Address Phone Number
Phone Number:
Cell Home Work
Alternate Phone Number:
Cell Home Work
Email:
If you have been previously licensed as an ofcial vehicle inspection station,provide the following:
____________________________________________________________ ______________________________________________________ ___________________
Station Name City, State Date
I verify the information provided below is true and correct, and I understand any required fee is non-refundable and non-transferrable. I also understand
this is an ofcial government record and any missing information and/or false statement made on this document or any other supplement provided to DPS
may result in denial of application and/or criminal prosecution.
____________________________________________________________ _________________________ _______________________________________________
Signature of Owner #1 (No Stamped Signatures) Date Printed Name and Title
0029-
0030-
7130-
VEHICLE INSPECTION STATION APPLICATION
•
MUST USE MOST CURRENT FORM
•
TYPED PREFERRED OR PRINT C LE A RLY
•
MAKE SURE ENTIRE CIRCLE IS FILLED
EXAMPLE: Yes No
FOR DPS USE ONLY
Residence
/Physical
Address
Address:
City: State: ZIP + 4: County:
Mailing
Address
Address:
City: State: ZIP + 4: County: