Application For:*

Class 1 ATV (4-Wheeler) Class 2 ATV (Side-by-Side) Utility Task Vehicle

Mini Truck Motorized Golf Cart

Application Information

Name:*

Date of Birth:*

Street Address:*

City:*

State:*

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Cell Phone:*

Home Phone:

Driver's License Number:*

Driver's License State:*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Vehicle Description

Make/Model:*

Description of Vehicle:*

Serial/VIN Number:*

Insurance Company Policy Number (Attach Copy):*

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Please List your Email address:*

Once the application is reviewed, you will be requested to pick the permit up and pay the appropriate fee at the Becker Police Department. The person requesting the permit must appear in person with a government issued photo ID to sign the permit application form to receive the permit. Please contact the Becker Police Department at 763-200-4267 with any questions.