YOUR RESOURCE

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

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Station Certification Application (NEW Stations ONLY)

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

SECTION A - OWNER INFORMATION
Franchise
Sole Proprietor
Corporation
Partnership
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
No
Yes
No

SECTION B - STATION INFORMATION

Franchise

Sole Proprietor

Corporation

Partner 1

Partner 2

Partner 3

Partner 4

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.
Check this box if your station address is the same as your mailing address.
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.
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.

WORLD WIDE
SPX/BOSCH
ESP/OPUS

WORLD WIDE
SPX/BOSCH
ESP/OPUS

WORLD WIDE
SPX/BOSCH
ESP/OPUS

SECTION C - TYPE OF CERTIFICATION DESIRED
Yes
No
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Public Test and Repair Station
Public Test Only
Commercial or Government Fleet
       (no public tests)
Used Car Dealer
New Car Dealer
Mobile Test Unit (No Public tests)
Dealer Only (No Public tests)

SECTION D - INSURANCE INFORMATION
Yes
No
Yes
No

SECTION E - STATION INSPECTOR LIST
Inspector Name
Certification Number
Not Yet Certified
or
or
or
or
or
or
or
or
or
or
0


SECTION F – SITE EVALUATION QUESTIONAIRE
Please check the appropriate boxes that apply to your proposed station.
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

Attach Files (7 required)

Current years' business license

Current W-9 for the business

Certificate of Liability Insurance.

Photo ID (Driver's License/State ID) - required from the station owner only

Verification of Lawful Presence with the United States - this form must be notarized

Site plan drawing

Documentation from your Internet service provider, including the static IP address.

If your service provider has not provided you with proof of your static IP address, your certification or re-certification application may be delayed.
7

Attach Another File


SECTION G – CONFIRMATIONS & SIGNATURE

Electronic Signature
05.26.2022