Business Registration Form

Businesses that dispatch delivery workers on bicycles in New York City and whose primary site of operation is either located outside New York City or not open and accessible to the public will be required to register with NYC DOT using this form.

Section 1: Name of Business

Name, doing business as

Name of business owner (individual)

Name of business owner (entity)

Business address

City/Town

State/Province

ZIP/Postal Code

Name of any business subsidiaries operating in New York City (list name and entity names)

Name of any business subsidiaries operating in New York City (list name and entity names)
Name of any business subsidiaries operating in New York City (list name and entity names)

Section 2: Contact information

List a point of contact (a person or team within the business) who will be responsible for all communications with NYC DOT.

Contact name

Contact title

Email address

Phone number

Mailing address

City/Town

State/Province

ZIP/Postal Code

Section 3: Registered Agent

Name and address of the registered agent upon whom process may be served and/or mailed. If the business has designated the NYS Secretary of State as its agent for receiving such process, the address to which the NYS Secretary of State may mail a copy of such process.

Registered agent name

Registered agent address

City/Town

State/Province

ZIP/Postal Code