1-800-642-9066
dmv.wv.gov
West Virginia Department of Transportation
Division of Motor Vehicles
Application for Clearinghouse Non-Resident Business Participation
A) Non-Resident Business Information
COMPANY NAME
FEDERAL TAX ID NUMBER (FEIN)
COMPANY ADDRESS
(STREET / CITY / STATE / ZIP CODE)
FULL NAME
(FIRST / MIDDLE / LAST)
B) Primary Contact Person
TELEPHONE NUMBER DIRECT LINE, NO CALL CENTERS
MAILING ADDRESS IF DIFFERENT FROM COMPANY ADDRESS
(STREET / CITY / STATE / ZIP CODE)
EMAIL ADDRESS
JOB TITLE
FULL NAME
(FIRST / MIDDLE / LAST)
C) Secondary Contact Person
TELEPHONE NUMBER DIRECT LINE, NO CALL CENTERS
MAILING ADDRESS IF DIFFERENT FROM COMPANY ADDRESS
(STREET / CITY / STATE / ZIP CODE)
EMAIL ADDRESS
JOB TITLE
D) Transaction Information
ESTIMATED VOLUME OF VEHICLE TITLE TRANSACTIONS TO BE PROCESSED ANNUALLY
E) Certication
SIGNATURE OF AUTHORIZED AGENT
(X)
DATE
PRINTED NAME OF COMPANY
PRINTED NAME OF AUTHORIZED AGENT
JOB TITLE
TELEPHONE NUMBER
I hereby certify and arm under penalty of nes and/or imprisonment that all information presented in this form and all
documents attached thereto are true and correct.
EMAIL
MV-101-CH Pg. 1 of 2 Orig. 05/2023
INSTRUCTIONS: Application for Clearinghouse Non-Resident Business Participation
Checklist
Is the application completed, including
signatures?
Did you enclose a check or money order
payable to the Division of Motor Vehicles
for the total fees and payment due?
Do you have all required documents listed
in the instruction section?
MAIL ALL REQUIRED DOCUMENTS, FORMS, AND PAYMENT TO:
Division of Motor Vehicles
Clearinghouse Department
PO Box 17800 OR
Charleston, WV 25317
Toll-Free Telephone (In-State Only) 1-800-642-9066
Out-of-State (304) 558-3900
MV-101-CH Pg. 2 of 2 Orig. 05/2023
▪ Type or complete this application in BLUE OR BLACK INK ONLY.
▪ DO NOT SEND CASH. SEND CHECK OR MONEY ORDER payable to the Division of Motor Vehicles. Any check that is
not honored for payment will result in a $10.00 SERVICE CHARGE.
▪ Fee for a rst-time applicant is $400.00. Fee for renewal is $200.00. Application fees are non-refundable.
▪ Make sure all required forms are included with this application:
• If you are a rst-time applicant, please include:
◦ $400.00 Application Fee
◦ Proof of Valid US Business License From Your State of Residence
◦ NIST Level 2 Letter of Attestation
◦ Information Security Questionnaire Form
◦ SOC II Type II Record of Compliance (ROC) Report
◦ $250,000 Bond (MV-100-CH)
• If you are renewing, ensure that you meet the required qualications and submit the appropriate documents:
◦ $200.00 Renewal Fee
◦ Proof of Valid US Business License From Your State of Residence
◦ Submit Annual Security PenTest Report
◦ Submit Annual SOC II Type II Record of Compliance (ROC) Report
◦ Maintain Less Than 10% Manual Reviews
◦ Maintain Less Than 2% Data Error Rates
◦ Provide Certicate of Completion Per eSignature (Upon a Request During an Audit Review)
◦ Maintain Less Than .05% Fraud Rates
◦ Maintain Less Than .05% Post-Title Correction Rates
5707 MacCorkle Ave., SE
Charleston, WV 25304
