Date

License Number

Shall be limited to no more than two owner/operators Must be over 18 years old and have a valid Driver’s License Shall be limited to no more than two owner/operators Must be over 18 years old and have a valid Driver’s License

1st Owner/Operator 1st Owner/Operator

Name

Date of Birth

Driver’s License Number

DL Copy

Full Address

2nd Owner/Operator 2nd Owner/Operator

Name

Date of Birth

Driver’s License Number

DL Copy

Full Address

Place of Business

Full Address

Insurance and Golf Cart Information Insurance and Golf Cart Information At least Liability Coverage

Insurance Company

Copy of Insurance Card

Policy Number

UTV Make

UTV Model

UTV Serial Number

Signature of person making application (must be owner/operator)

License Number