This form contains 20 fields organized into 7 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Applicant Address (Street, City, State, ZIP)
Applicant State Text
Enter the applicant's U.S. state of residence using the two-letter postal abbreviation (for example: TX).
Applicant Street Address Text
Enter the applicant's street address including apartment or unit number if applicable (for example: 123 Main St, Apt 4B).
Applicant City Text
Enter the city for the applicant's mailing address as used for postal delivery.
Applicant ZIP Code Text
Enter the applicant's postal ZIP code or ZIP+4 for the mailing address (for example: 75001 or 75001-1234).
Applicant Contact Information
Applicant Email Text
Enter the applicant’s email address for contact purposes (e.g., [email protected]).
Applicant Phone Number Text
Enter the applicant’s daytime phone number including area code so the office can contact you if needed.
Applicant Name and County
First Name Text
Enter your given first name exactly as you want it to appear on the replacement plate/registration and as it appears on your driver’s license or vehicle records.
Middle Name Text
Enter your middle name or middle initial, or leave blank if you do not have one.
Last Name Text
Enter your family or surname exactly as it appears on your driver’s license or vehicle registration.
Suffix Text
Enter any name suffix (for example Jr., Sr., II, III) if applicable, or leave blank if none.
County Text
Enter the name of the county where you live or where the vehicle is registered.
Certification Date
Certification Date Date
Enter the date you are signing or certifying the statement above.
Replacement Items Requested
Current license plate(s) Checkbox
Check this box if you need to replace your current vehicle license plate(s).
Current plate registration sticker Checkbox
Check this box if you need to replace the registration sticker that is on your license plate.
Current windshield registration sticker Checkbox
Check this box if you need to replace the registration sticker that is displayed on your windshield.
Vehicle Details (Year, Make, Body Style)
Vehicle Year Text
Enter the vehicle model year (e.g., 2020) as shown on the vehicle title or registration.
Vehicle Make Text
Enter the vehicle manufacturer/brand (e.g., Toyota, Ford) exactly as shown on the title or registration.
Body Style Text
Enter the vehicle body style or type (e.g., sedan, pickup, SUV) as it appears on the vehicle documents.
Vehicle Identification (VIN and Current TX Plate)
Vehicle Identification Number (VIN) Text
Enter the vehicle's full VIN exactly as shown on the vehicle title or registration (typically 17 characters, including letters and numbers).
Current TX License Plate (Prior to Replacement) Text
Enter the current Texas license plate number that is being replaced, exactly as it appears on the plate (include letters, numbers, and any punctuation).