Dealer License Application Form

DEALER LICENSE APPLICATION FORM

WHEREAS, the Applicant seeks authority to operate as a Dealer of motor vehicles and related goods and services; and

WHEREAS, issuance of a dealer license is conditioned upon satisfactory disclosure, payment of required fees, provision of bond and insurance, and compliance with all applicable state and local statutes and regulations; and

NOW, THEREFORE, Applicant submits the following information, certifications, and authorizations in support of this application and understands that materially false statements or omissions may subject Applicant to denial, revocation, fines, or criminal penalties.

A. APPLICATION DETAILS

Application Date:    County of Business:

B. BUSINESS LOCATION & CONTACT

Business Phone:    Business Email:

Business Start Date:    Is the location owned or leased?   Owned   Leased

C. BUSINESS IDENTIFIERS & FINANCIAL

Federal Employer ID Number (EIN):    State Sales Tax Permit #:

Primary Contact Name:    Title:

D. ENTITY TYPE & BUSINESS ACTIVITY

Entity Type:   Sole Proprietor   Partnership   Corporation   LLC

Dealer Activities (select all that apply):   New Vehicles   Used Vehicles   Wholesale   Parts Sales   Motorcycles   Trailers

E. OWNERS, PARTNERS, OFFICERS

Provide all individuals or entities with direct ownership or control of 10% or more. Attach additional pages if needed.

Title:    Home Address:

Title:    Home Address:

F. BOND, INSURANCE, AND FINANCIAL SECURITY

Bond Number:    Bond Amount: $

Policy Number:    Minimum Liability Limits:

G. ATTACHMENTS & DOCUMENTS

Check all documents attached to this application (required attachments will be verified by the licensing authority):

Surety bond or proof of bond
Certificate of liability insurance
Copies of government-issued ID for owners/officers
Lease or deed for the business premises
Sales tax permit or reseller certificate
Current vehicle inventory list
Recent financial statements (if requested)

H. CRIMINAL HISTORY & DISCLOSURES

Has any applicant, owner, officer, or manager ever been convicted of or pled nolo contendere to a felony or a crime involving fraud, theft, or dishonesty?   No   Yes

I. SCOPE OF BUSINESS / INVENTORY DESCRIPTION

Describe the primary scope of dealer operations, inventory sources, and customary business practices (sales channels, auctions, consignments, retail, wholesale):

J. FEES & PAYMENT

Application Fee: $    Licensing Fee (if assessed): $

Payment Method:   Check   Money Order   Credit / Debit Card   Other

Late Fee Policy: Applicant acknowledges that late payment of any required fee may result in an administrative late fee, suspension of application processing, or denial of license. A past-due account may accrue additional administrative penalties until resolved.

K. CERTIFICATIONS, AUTHORIZATIONS AND LEGAL NOTICES

Certification: Applicant certifies under penalty of perjury that all statements and attachments furnished with this application are true, complete, and correct to the best of Applicant's knowledge. Applicant understands that submission of materially false information is grounds for denial, revocation, fine, or other legal sanctions.

Authorization for Background Checks and Records Release: Applicant authorizes the licensing authority to obtain and verify criminal, civil, financial, and licensing records concerning Applicant, and to disclose such records to other government entities as permitted by law. Applicant releases the licensing authority and its agents from liability for release of such information in good faith.

Confidentiality and Public Records: Applicant acknowledges that information submitted may be subject to disclosure under applicable public records laws. Proprietary financial information may be treated in accordance with applicable confidentiality provisions, but no guarantee of nondisclosure is made.

Compliance with Law: Applicant agrees to comply with all applicable statutes, administrative rules, taxes, reporting requirements, and consumer protection laws governing the operation of a vehicle dealer. License issuance does not relieve Applicant of separate local permits, zoning, or tax obligations.

Governing Law: This application, the processing thereof, and any license issued pursuant to this application shall be governed by the laws of the state in which the application is filed. Any dispute regarding license issuance or denial shall be subject to applicable administrative procedures and judicial review.

Entire Application: Applicant acknowledges that this completed application, together with attachments and any written determinations issued by the licensing authority, constitute the entire submission and agreement concerning licensing matters, superseding prior communications.

L. ACKNOWLEDGMENT

I hereby certify that I am authorized to execute this application on behalf of the Applicant and that the information contained herein is true and accurate. I understand that issuance of a dealer license is contingent upon compliance with all licensing requirements and the furnishing of any additional information requested by the licensing authority.

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