YOUR RESOURCE

for Georgia's Vehicle Emissions Inspection & Maintenance (I/M) Program.

Station Information Update Form

Please attach documentation from your Internet service provider, including the static IP address.

For minor station updates, complete the appropriate field(s) below. Only the station owner or authorized representative can sign the completed form and initial the Site Plan Drawing. If you have any questions or need help filling out this form, please call GCAF Station Assistance at 1.800.449.2471, Option #2.

NOTE: Updates to station ownership or station address* must be completed using the Station Certification Application.

By checking this box I give GCAF permission to forward my email address to the Industry Advisory Board (IAB) so that I may receive current IAB updates and membership information.
By checking this box I give GCAF permission to forward my email address to the Industry Advisory Board (IAB) so that I may receive current IAB updates and membership information.

1. Add Station Manager
By checking this box I give GCAF permission to forward my email address to the Industry Advisory Board (IAB) so that I may receive current IAB updates and membership information.

2. Add Station Manager
By checking this box I give GCAF permission to forward my email address to the Industry Advisory Board (IAB) so that I may receive current IAB updates and membership information.

3. Add Station Manager
By checking this box I give GCAF permission to forward my email address to the Industry Advisory Board (IAB) so that I may receive current IAB updates and membership information.

Yes (Attached)
No
Yes (Attached)
No
Yes
No (1996 and newer vehicles only)
Yes
No
Yes
No
Change ACH banking information


Attach W-9 and Static IP Documentation

Please attach documentation from your Internet service provider, including the static IP address.

1

Attach Another File


Electronic Signature
12.17.2017