Motorists Stations Repair Industry Contact Us

Station Information Update Form

For minor station updates, complete the appropriate field(s) below. Only the station owner or authorized representative can sign the completed form and initial the Site Plan Drawing. If you have any questions or need help filling out this form, please call GCAF Station Assistance at 1.800.449.2471, Option #2.

NOTE: Updates to station ownership or station address must be completed using the Station Certification Application.

Station ID GA*

Station Name*

GAS ID*

Station Email*

Industry Advisory Board:

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.

Ownership Information

Update to business/corporation name

Owner First Name

Owner Last Name

Owner Email*

Industry Advisory Board:

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.

Update to Owner/CEO Home Address Line 1

Update to Owner/CEO Home Address Line 2

City*

State*

Zip Code*

Station Information

Update to Station Name (include copies of business license and insurance)

Updated Station Phone Number

Update to Station Address Line 1

Update to Station Address Line 2

Station City*

Station State*

Station Zipcode*

Station County*

Update Station Managers

New Station Manager 1

First Name

Last Name

Phone

Industry Advisory Board:

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.

New Station Manager 2

First Name

Last Name

Phone

Industry Advisory Board:

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.

New Station Manager 3

First Name

Last Name

Phone

Industry Advisory Board:

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.

Remove Station Manager

First Name

Last Name

Configuration Changes

Adding/Changing out a GAS*:

Yes (Completed Site Plan Diagram Attached)

Analyzer Make

Moving Analyzer within Station*:

Yes (Completed Site Plan Diagram Attached)

Change ACH banking information

Model Number

Serial Number

Static IP Address

Attach Files

Static IP Documentation:* Please attach documentation from your Internet service provider, including the static IP address.

Current W-9 for the Business:* Download W-9 Form

Completed Site Plan: Required if you are adding, changing, or moving GAS.

Business Documentation with New Station Name: Required if you are changing the name of your station.

Attach More Files

Electronic Signature

As the applicant, I certify and represent, under the penalty of law, the information provided herein, and all accompanying documentation supplied with this application, is true, correct and authentic. I understand and acknowledge that submitting false information or fraudulent statements or writings in a matter under the jurisdiction of a state agency is a crime and can result in fines, imprisonment or both (O.C.G.A 16-10-20).

Further, by entering my name in the field below, I am authorized to bind the above referenced inspection station, and I fully authorize the Georgia Environmental Protection Division (EPD) and Opus Inspection, Inc. to accept it as the equivalent signature for any and all purposes, including civil and criminal enforcement actions.

Applicant or Registered Owner Signature (Electronic Signature)

First Name

Last Name

Date

Mar 25, 2025