MPP/MVP Membership Application Form

Please fill out your city or town’s contact information and Federal Employer Identification Number (FEIN).

Legal Name of Entity

Main Phone Number

Which program are you interested in?

Vehicle Property Both

Physical Address

Mailing Address

What is your Federal Employer Identification Number (FEIN)?

Contact's First Name

Middle Initial

Contact's Last Name

Contact's Email Address

Is this email address shared?

Yes No

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