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Golf Cart Registration Form

Golf Cart Owner Registration

Town of Stedman, North Carolina


Golf Cart Owner’s name(s): ______________________________________________________


Owner’s Physical Address: _____________________________________________________


City/Town: _________________________   State: ____________   Zip: _________________


Owner’s Mailing Address: ______________________________________________________


City/Town: _________________________   State: ____________   Zip: _________________


Owner’s Telephone No. Daytime: (_____)____________ Night time: (_____)______________


Owner’s Driver’s License Number: ________________________ State: __________________


Make of Golf Cart (Mfg): _______________________________________________________


Color of Golf Cart: ________________________  Model (Year): _______________________


Serial Number of Golf Cart: ____________________________________________________


Liability Insurance (Company, Policy Number, Insured): ________________________________



*** Please Attach Copies of Liability Insurance AND Driver’s License ***


I have received, read and understood the “Golf Cart Ordinance”. I have paid the inspection fee for the above cart. I acknowledge that I will assume all liability, and am fully responsible for the operation of the above cart on the streets and public vehicular areas in the Town of Stedman. I also acknowledge that the Town of Stedman, in providing this privilege, is in no way endorsing the operation of this cart on the streets and public vehicular areas, and does not and will not assume any liability in the operation of the cart.  I agree to indemnify and hold harmless the Town of Stedman for any and all liability arising from the use of this golf cart. I will insure that the permit sticker and the Warning and Disclaimer of Liability will remain attached to the cart in the prescribed manner at all times.  I further agree that I will obey all the rules and regulations set forth by the Town of Stedman concerning the operation of a cart within town limits.


            _______________________________                      __________________________

                        Owner’s Signature                                                                  Date



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