Golf Cart & Slow Moving Vehicle Registration Form

Golf Cart & Slow Moving Vehicle Registration Form

Golf Cart & Slow Moving Vehicle Registration

For details on the rules governing the operation of Golf Carts and Slow Moving Vehicles in Church Point, please see Sections 40-90 through 40-93 of the Town of Church Point Code of Ordinances.

Owner/Registrant Name(Required)

First Last

Vehicle Model/Year(Required)

VIN/Serial #(Required)

Insurance Company Name(Required)

Insurance Expiration Date(Required)

Insurance Policy #(Required)

Driver's License #(Required)

Owner/Registrant Email(Required)

Owner/Registrant Phone(Required)

Owner/Registrant Address(Required)

Street Address Address Line 2 City State ZIP Code

Check All That Apply(Required)

Headlights

Front & Rear Turn Signals

Tail Lights

Brake Lights

Reflectors

Side Mirror OR Rear View Mirror

Parking Brake

Slow Moving Vehicle Triangle Sign On Rear

Please check the box to acknowledge your vehicle has each type of equipment.

Acknowledgements & Digital Signature(Required)

Indemnification - I hereby freely obligate myself as the undersigned owner and registrant to indemnify, defend, and hold the Town of Church Point, its officers, agents, servants, employees, assistants, legal representatives and their heirs, executives, executors, administrators, and assigns completely harmless from and against any and all liabilities, losses, suits, claims, judgments, fines, or demands arising by reason of injury or death of any person or damage to any property, including all reasonable costs of investigation and defense thereof, included but not limited to, attorney fees, court costs, and expert fees, of any nature whatsoever arising out of an incident to the acts or omissions of the Owner and Registrant, its officers, agents, employees, contractor, subcontractors, subleases, licensees, invitees, or any third party persons in use of the Owner's and Registrant's Golf Cart or Slow Moving Vehicle, regardless of where the injury, death, or damage may occur.

Acknowledgement of Receipt of Code Sections 40-90 through 90-93(Required)

Furthermore, by attaching my signature below, I hereby acknowledge that I have received access to Sections 40-90 through 40-93 of the Town of Church Point Code of Ordinances and understand that I am responsible for complying with the requirements contained therein.

Sections 40-90 through 40-93

Driver's License(Required)

Max. file size: 2 GB.

Upload an image of your driver's license.

Proof of Insurance(Required)

Max. file size: 2 GB.

Must insurance company name, policy #, and expiration date.

Vehicle VIN #(Required)

Max. file size: 2 GB.

This might be included on your proof of insurance.

Digital Signature(Required)

Please type your name above, which serves as your digital signature.

This field is for validation purposes and should be left unchanged.

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