New Organization Enrollment Form

Main Organization / Corporate Details
Main Organization / Corporate Contact*

First NameLast NameSuffix
Main Organization / Corporate Contact Email*
example@example.com
Main Organization / Corporate Contact Phone Number*
Please enter a valid phone number.
Organization / Corporate Legal Name*
Organization / Corporate DBA
If applicable.
Organization / Corporate Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code

Additional Organization / Dealership Points
Complete "Individual Organizations / Dealerships" only if you are a multi-point dealer group or organization. Not required for singular dealers/organizations.
Individual Organizations / Dealerships

Administrator(s)
Administrators will have full access to all transactions, across all sub-dealers/organizations.
Administrators*

Single Dealer Users
Single Dealer Users will have full access to all transactions, across a single sub-dealer/organization.
Single Dealer Users

ACH Information

Complete ACH Information to generate ACH Agreement
Auto Pay Preference

Authorize Auto-PayManually Authorize Tax/Fee Payments via Invoice
Bank Name
Bank Address

Street Address

Street Address Line 2

CityState

Zip Code
Account Type

CheckingSavingsOther
Name of Account Holder
Routing Number
Account Number

ACH Information

Enter Email, Follow DocuSign Instructions at Top of Module to Sign.
Enter your name and email into the module below. When prompted, drag and drop the "Signature" widget to sign agreement.

Credit Card Authorization

Complete Credit Card Authorization Fields to Generate Credit Card Authorization Form
Auto Pay Preference

Authorize Auto-PayManually Authorize Tax/Fee Payments via Invoice
Card Type

American ExpressDiscoverMasterCardVisaOther
Cardholder's Name
As shown on card
Billing Zip Code

Terms and Conditions

Scroll to the bottom of the Terms & Conditions to Continue

Completed Work Preferences

Please tell us where you'd like the customer's physical plates and documents to go after processing.
Physical Registration/Title/Plate Completion Should Be Delivered To:*

Organization/Dealership (your office)Customer AddressPer Transaction Basis - Take Direction from Org per transaction
Pre-Paid Label Preference*

Bill within tax estimate & fee breakdownOrganization/Dealership (your office) will provide labels to final destinationPer transaction (JGT will ask for authorization per transaction)

Refund Preferences

Tell us how you'd like to receive overage monies collected, if any apply.
Who should refund monies be payable to?*

The Organization/DealershipThe ClientPer transaction (JGT will ask for authorization per transaction)Other

Invoice Preferences

Tell us how you'd like to receive billing for monies underpaid, if any apply.
Who should invoices be billed to?*

The Organization/DealershipThe ClientPer transaction (JGT will ask for authorization per transaction)Other

Missing Document Preferences

Tell us how you'd like to receive notification/action for documents not collected, if any apply.
Who should we reach out to if document package is not complete or errors occur?*

The Organization/DealershipThe ClientPer transaction (JGT will ask for authorization per transaction)Other
Should be Empty:

Organization / Corporate Information