72 Hour Permit Order Form

Required fields are in Bold.

OWNER INFORMATION
Name
Company Name
Address
City
State
Zip Code
Phone Number {Example - (xxx) xxx-xxxx}
Quantity	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
The Next Two Fields are Optional
State of Registration
Expiration of Registration

CREDIT CARD INFORMATION	- We accept Visa, Mastercard, and Discover.
Select Card Type	SELECT A CARD VISA MASTERCARD DISCOVER
Your Name:
Email Address:
Billing Address
Billing City
Billing State
Zip (Postal Code):
Card Number:	(Numbers only, no dashes or spaces)
V Code

Where is the V-Code located? VISA, Mastercard, and Discover Card Requirements Card V-Code # 3-digit, non-embossed number printed on the signature panel on the back of the card immediately following the Visa card account number. This number is recorded as an additional security precaution

Expiration Date:

01 January 02 February 03 March 04 April 05 May 06 June 07 July 08 August 09 September 10 October 11 November 12 December 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

 
Comments or Special Instructions

 
Tag agent is not liable for items mailed to the above address.
Be sure vehicle described on this form is the vehicle you want to register.
Your Tag Agent will E-mail you with a Notification of Receipt.
 

ONLY PRESS SUBMIT ONCE!!!

Oklahoma Motor Vehicle Tax Commission Division Department of Public Safety Transportation Revenue Taxation Property Tax Requirements Copyright March 1999, January, 2002, OKtagagent.com™ Darby ~ Delancie™