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Get MN Mandatory Inspection Program Decal Order Form 2016

Minnesota Department of Public Safety State Patrol Division MANDATORY INSPECTION PROGRAM DECAL ORDER FORM Fill out information to the right. Return order form and remittance to TOTAL AMOUNT DUE FOR DECALS MN State Patrol CMV Section Any questions about the decal order please call the MN State Patrol Office 1110 Centre Pointe Curve 410 651 405-6173. Company Name Please type or print your name and mailing address legibly. It will be used as your return label* Company Telephone Number City State Zip Code 2016 DECALS For Vehicles inspected in 2016 How many decals would you like to order Decals are not refundable or exchangeable please order carefully. Please enclose 2. 00 per decal ordered* We cannot accept purchase orders. Make check or money order payable to STATE OF MINNESOTA. Mendota Heights MN 55120 Credit Card Orders You may scan and e-mail your orders to PATROL*MIPDECALSALES STATE*MN*US including inspector numbers in subject line. Scanned orders must include credit card number and expiration month and year. A service charge 4. 50 is assessed for credit card orders. PLEASE DO NOT FAX. Credit Card Number Month/Year It is hereby agreed that this inspector will recognize the critical criteria established by the State Patrol Division of the Department of Public Safety and shall place decals only upon vehicles which have passed the inspection as provided by law. Should it ever be determined that this inspector has issued decals without regard to all provisions set forth in 49 CFR 396. 17 and M. S* 169. 781 the privileges of performing certified inspections may be revoked* Decals listed below are to be used only by the inspector who has signed this form* Use by any other person is strictly prohibited* Agreed by Certified Inspector s Signature Date Inspector Certification Number Print Inspector Name For Office Use Only Beginning Decal Ending Decal Transaction Type Check Date Issued//201 Issued by Revised 10/27/2015. Company Name Please type or print your name and mailing address legibly. It will be used as your return label* Company Telephone Number City State Zip Code 2016 DECALS For Vehicles inspected in 2016 How many decals would you like to order Decals are not refundable or exchangeable please order carefully. Please enclose 2. 00 per decal ordered* We cannot accept purchase orders. Make check or money order payable to STATE OF MINNESOTA. Mendota Heights MN 55120 Credit Card Orders You may scan and e-mail your orders to PATROL*MIPDECALSALES STATE*MN*US including inspector numbers in subject line. Scanned orders must include credit card number and expiration month and year. A service charge 4. 50 is assessed for credit card orders. Scanned orders must include credit card number and expiration month and year. A service charge 4. 50 is assessed for credit card orders. PLEASE DO NOT FAX. Credit Card Number Month/Year It is hereby agreed that this inspector will recognize the critical criteria established by the State Patrol Division of the Department of Public Safety and shall place decals only upon vehicles which have passed the inspection as provided by law. .

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