Form 96 0104 - Fill out the applicant and vehicle information sections of the form. Visit any mvd office or authorized third party office, or write to request disability plates and placards. Web disability plates may be personalized for an additional fee of $25 per year for standard personalized plates or $50 per year for specialty personalized plates. All choices are subject to approval. Web download the form: Have your healthcare provider complete the medical certification section of the form. Must be signed by an arizona physician, registered nurse, nurse practitioner, audiologist, or hospital administrator.
Web disability plates may be personalized for an additional fee of $25 per year for standard personalized plates or $50 per year for specialty personalized plates. All choices are subject to approval. Fill out the applicant and vehicle information sections of the form. Have your healthcare provider complete the medical certification section of the form. Visit any mvd office or authorized third party office, or write to request disability plates and placards. Must be signed by an arizona physician, registered nurse, nurse practitioner, audiologist, or hospital administrator. Web download the form: