Louisiana Office of Motor Vehicles

Business Information:
*Business Name:		Required
*EIN:		Required Numbers only
*Street Address:		Required

*City:
*Zip Code:		Required 5 digits
*Phone:		Required Only digits allowed, 10 minimum
FAX Number:		Only digits allowed, 10 minimum
Cell Phone:		Only digits allowed, 10 minimum
*Email:		Required Invalid Email
*Re-enter Email:		Required Emails not a match
*No. of Agents Requested:		Required 1-99
*License Number:		Required

Point of Contact Information:
*P.O.C. Name:		Required
* Street Address:		Required

*City:
*State:
* Zip:	City Zip Look Up	Required 5 numbers
*Phone:		Required Only digits allowed, 10 minimum
*Login Email:		Required Invalid
*Re-enter Login Email:		Required Emails not a match

*= required field
Note: The POC counts as one of the agents.