Clean Vehicle Pass Application

Application Info

The Clean Vehicle Program cost is $10. Payment information will be emailed when you are offered a pass.
All fields marked with (*) are required and must be filled in for the application to be submitted.
The owner's first and last name or company name must match the name on the vehicle registration. If the vehicle is registered under a company name only, enter n/a in the first and last name fields and enter the name of the person completing the application in the notes field.
Permanent license plate numbers are required at the time of application.
The address entered on the application must match the address on DMV records. Addresses can be updated at:http://dmv.utah.gov/.
To transfer a pass – Include your current permit number, license plate number, VIN or pass number in the appropriate section of the application.

Vehicle Owner's Name

First Name

Middle Name

Last Name

Vehicle Co-Owner's Name

Coowner First Name

Coowner Middle Name

Coowner Last Name

Company Name

Owner Contact Information

Street Address

City

Zip

The mailing address is different

Phone

Email:

Email Confirmation:

Vehicle Information

Year

Make

Model

Vehicle Identification Number:

License Plate

Fuel Type

Transfer Request?
Click here for transfer information.

Other Notes