Mechanic Registration

Mechanic Info

*Driver's License #:

*Address:

*State:

*City:

*Zip Code:

*First Name:

Middle:

*Last Name:

*Phone:

Ext:

e.g. 802 123 4567 Ext: 12345

*Email:

Certification Info

*License Type:

School Bus

Motorcycle/Motor-Driven Cycle

Car/Truck/Heavy Duty Truck/Bus(Non-School Bus)/Trailer

Initial Certification Date:

Last Certification Date:

Expiration Date:

*Enter the verification code characters shown on the left

If you can't see clearly, click 'Change the characters above' button to regenerate the image