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Base Electronic Affirmation for LARS New Vehicle Applications


THIS FORM CAN ONLY BE SUBMITTED BY A BASE OWNER, PARTNER OR OFFICER.

This affirmation is for NEW VEHICLE ONLINE APPLICATIONS ONLY.

This affirmation is only valid for 7 days from the date submitted.

Once the Affirmation has been submitted, please allow up to 10 minutes for the information to be processed. The vehicle owner will be notified via email that the Affirmation was filed and they will be able to submit the New Vehicle Application online.

BASE INFORMATION  
Base/Authority Name:
Base License Number:  (This is not me.)
Submitted by:
Applicant Name:
VIN Number:
Re-enter VIN Number:
Vehicle Owner's Cell Phone #:
Contact Phone Number:
Vehicle Owner's Email Address:
Confirm Email Address: