MVR – Motor Vehicle Records – Total Effects Inc

Total Effects Inc.

MVR – Motor Vehicle Records
AFFIDAVIT OF INTENDED USE

THIS FORM IS REQUIRED FOR OBTAINING YOUR MOTOR VEHICLE RECORDS. PLEASE COMPLETE THIS FORM ENTIRELY AND SIGN IT/DATE IT.

PART A: TO BE COMPLETED BY THE DRIVER

Name*

First Name Last Name

Email Address*

Phone Number*

CDL-A experience*

Driver Work History

1: Start-End Month/Year*

1: Company Name*

1: Truck & Trailer Type*

2: Start-End Month/Year

2: Company Name

2: Truck & Trailer Type

3: Start-End Month/Year

3: Company Name

3: Truck & Trailer Type

4: Start-End Month/Year

4: Company Name

4: Truck & Trailer Type

5: Start-End Month/Year

5: Company Name

5: Truck & Trailer Type

6: Start-End Month/Year

6: Company Name

6: Truck & Trailer Type

7: Start-End Month/Year

7: Company Name

7: Truck & Trailer Type

Additional information about Driver Work history:

Any Moving Violations (Tickets) in the past 3 years?*

Date of birth:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

CDL Number:*

CDL State:*

CDL Expiration:*

SSN #*

Upload CDL-A photo*

Accepted file types: jpg, png, , Max. file size: 5 MB.

INFORMATION MAY BE USED ONLY FOR THE FOLLOWING APPROVED DRIVER PRIVACY PROTECTION ACT (DPPA) PURPOSES. SELECT THE PURPOSE(S) FOR WHICH YOU WILL BE ORDERING MVRS:

SELECT THE PURPOSE(S)*

By a business that will use the information to verify the accuracy of information submitted by individuals for the purposes of preventing fraud, pursuing legal remedies against or recovering a debt or security interest.

By an insurer or insurance support agency in connection with claims, investigations, antifraud activities, rating or underwriting.

By an employer/agent or insurer to obtain or verify information on a Commercial License Holder.

Written consent of the person whose record is being requested (Available in: AR, CA, CO, DC, FL, HI, IL, KY, MA MN, NM, NY, ND, RI, VT, VA, WY)

Under the penalty of perjury, I attest that I shall not obtain, resell, transfer, or use the information in any manner prohibited by law. I understand that motor vehicle or driver records that are obtained, resold, or transferred for purposes prohibited by law may subject me to civil penalties under federal and state law.

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Ip Address

This field is for validation purposes and should be left unchanged.

(919) 2477760

(313) 3103064

414 Southtown Circle, Rolesville, NC 27571

08:00AM - 05:00PM

MVR – Motor Vehicle Records

Total Effects Inc.

PART A: TO BE COMPLETED BY THE DRIVER

Driver Work History

Obtaining further information by make a contact with our experienced freight staffs.

Reach out now!

(919) 2477760

info@tefreights.com

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Monday - Friday : 08:00AM - 05:00PM

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