APPLICATION FOR WMI CODE


DATE
Fri Dec 15 09:15:05 EST 2017
1. Is this the first request that has been made for a WMI form someone with your company?:

No
Yes
2. Is the vehicle complete when it leaves your company?:

No
Yes
3. Is the vehicle for on road use?:

No
Yes
4. Do you manufacture more or less than 900 vehicles per year?:

More
Less
Owner/President of Company
Contact Name:
Company Name:

Company Information
Address
City
Country
Zip Code

Plant Information
Address
City
Country
Zip Code
Phone Number:
Fax:
Email:
Trade Name of Vehicle:
Type of Vehicle:

Passenger car
Multipurpose passenger vehicle
Truck
Bus
Motorcycle
Motor driven cycle
Trailer
Low-speed vehicle