Request to Participate in Rapid Renewal Service

General Information

Municipality:

Population:

Street address:

Zip Code:

Average number of vehicles registered annually:

Do you have a municipal web site?:

Select Yes No

If yes, what is the web address (URL):

Do you receive inquiries from your citizens about online registration?:

Select Yes No

If yes, how often?:

Select Daily Weekly Monthly

Do you use electronic registration software?:

Select Yes No

If yes, indicate your e-reg vendor:

Select Gemini Northern Data Trio Network Systems

Municipal Contact Information

Municipal Contact Person:

Contact Title:

Contact Phone:

Contact Email:

Municipal Official Information

Name of municipal official with contracting authority:

Title:

Your Information

Your name:

Title: