SR-E-291E (2019/07) © Queen's Printer for Ontario, 2019 Disponible en français

Ministry of Transportation

Motor Vehicle Inspection Station (MVIS) UnitStructural Inspection Certificates Order Form

InstructionsComplete and send to:

Ministry of Transportation MVIS Unit 301 St. Paul Street, 8th Floor St. Catharines ON L2R 7R4 Fax 905-704-2574

Please allow four to six weeks for delivery. For additional information please visit our website www.mto.gov.on.ca or call 416-246-7166 or 1-800-387-7736.

Station DetailsLicensee Name MVIS Licence Number

Station AddressUnit/Apt/Suite Number Street Number Street Name PO Box

Lot Number Concession Township City/Town/Village

Province Postal Code/Zip Code Country

Order Information

Number of books Price per book ($) Total Fee ($)

Structural Inspection Certificates (10 per book) (each book includes 15 Rebuilt Vehicle Parts Audit Forms)

Total $Method of PaymentAll personal cheques must be certified unless payment is sent by mail

Cheque Make payable to the "Minister of Finance/MTO". Please note that we do not accept post dated cheques.

Amount ($) Credit Card Please fill in and attach the Credit Card Authorization Form (SR-LV-034).

Amount ($)

Stored Credit Amount ($) Certified Cheque Make payable to the "Minister of Finance/MTO".

Amount ($)

Money Order Make payable to the "Minister of Finance/MTO".

Amount ($) Prepaid Account Amount ($)

SignatureName of Licensee/Representative/Service Provider

Signature of Licensee/Agent/Representative/Service Provider Date (yyyy/mm/dd)