APPLICATION FOR A LICENSE AS A MOTOR VEHICLE, …

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

DIVISION OF MOTORIST SERVICES

PLEASE SUBMIT THIS APPLICATION TO THE REGIONAL OFFICE RESPONSIBLE FOR YOUR DEALERSHIP

APPLICATION FOR A LICENSE AS A MOTOR VEHICLE, MOBILE HOME OR RECREATIONAL VEHICLE DEALER

OFFICE USE ONLY Entered by:

Approved by:

Do not use white out or correction tape on this application.

I hereby make application and submit the required documentation for an original license or a corporate officer update:

VF Franchised Motor Vehicle Dealer ? 320.27, F.S.

SF Franchised Motor Vehicle Service Facility ? 320.642(6), F.S VI Independent Motor Vehicle Dealer ? 320.27, F.S.

Original

VW Wholesale Motor Vehicle Dealer ? 320.27, F.S. VA Motor Vehicle Auction ? 320.27, F.S.

Dealer Development Franchise (Attach copy of the Dealer

SD Salvage Vehicle Dealer ? 320.27, F.S. BH Used Mobile Home Broker ? 320.77, F.S.

Development & Management Agreement.)

DH Mobile Home Dealer- 320.77, F.S. DH Selling New Recreational Vehicles ? 320.771(8), F.S. DH Selling Used Recreational Vehicles ? 320.771(8), F.S. DH Selling Park Trailers Only - 320.771(3)(j), F.S. RV New Recreational Vehicle Dealer ? 320.771, F.S.

RU Used Recreational Vehicle Dealer ? 320.771, F.S.

Corporate Officer Update Modification Only (Please complete the application in its entirety. Page 5 of this application must be completed for all incoming new officers.

Current License No.:

Sales Tax Number:

FEID Number:

Proof of Identification/DL, if Sole Proprietor or Partnership:

Please see instruction guide for acceptable proof of identification.

Owner/Partner/LLC/LLP/LLLP or Corporation Name:

LICENSE NUMBER ISSUE DATE

DATE RECEIVED IN REGIONAL OFFICE

DATE COMPLETED IN REGIONAL OFFICE

DATE MAILED TO HEADQUARTERS

DATE RECEIVED IN DEALER LICENSE

SECTION

AMOUNT

Fictitious Business Name (d/b/a):

CHECK

Dealership Physical Address:

Street Address (Enter Physical Address even if same as Mailing Address)

City

Mailing Address:

County

State Street Address

Zip Code

City

Telephone Numbers:

County

Home: (

)

Office: (

)

State

Cell No.: (

)

FAX No.: (

)

Zip Code

None

Business E-mail Address:

Surety Bond Company E-mail Address: _____________________________________________________

Garage Liability Insurance Company E-Mail Address: __________________________________________

1. If franchised or a recreational vehicle dealer, list authorized line make(s) for which you are already licensed to sell:

CHECK NUMBER CASH CREDIT CARD

PAYMENT NUMBER

FRVIS CUSTOMER NUMBER

DIVISION CORP ACTIVE INACTIVE

Motorcycles greater than 50cc, 1492 watts, 2bhp

Motorcycles 50cc or less, 1492 watts or less, 2bhp or less

Tri-Vehicles

Low Speed Vehicles

Recreational Vehicles

Park Trailers

2. If applying for an original franchised license or a recreational vehicle dealer license, list the line make(s)

you are seeking for approval:

Motorcycles greater than 50cc, 1492 watts, 2bhp

Motorcycles 50cc or less, 1492 watts or less, 2bhp or less

Tri-Vehicles

Low Speed Vehicles HSMV 86056 Rev. 9/21

Recreational Vehicles

Park Trailers

DEALER TRAINING SCHOOL

COMPLETION DATE

Zone #:

Insp #:

APPLICATION FOR A LICENSE AS A MOTOR VEHICLE, MOBILE HOME, OR RECREATIONAL VEHICLE DEALER

Do not use white out or correction tape on this application.

3. Sole Proprietor

Partnership

Corporation

Limited Liability Company/Partnership (LLC/LLP) Limited Liability/Limited Partnership (LLLP)

A. OWNERS/PARTNERS:

Last Name

First Name

Middle Initial

(FRVIS Customer No. ? Office Use Only)

Date of Birth

FL DL/ID# (if other proof of ID is used, attach copy) Home Phone Number w/ Area Code

Daytime Phone Number w/ Area

Residence Address

City

State

Zip Code

(Fingerprint date-Office Use Only)

Last Name Date of Birth

First Name

Middle Initial

FL DL/ID# (if other proof of ID is used, attach copy) Home Phone Number w/ Area Code

(FRVIS Customer No. ? Office Use Only) Daytime Phone Number w/ Area Code

Residence Address

City

State

Zip Code

(Fingerprint date-Office Use Only)

Last Name

First Name

Middle Initial

(FRVIS Customer No. ? Office Use Only)

Date of Birth

FL DL/ID# (if other proof of ID is used,

Residence Address

City

State

Zip Code

(Fingerprint date-Office Use

B. CORPORATE/LLC/LP/LLP/LLLP:

Corporate Name

Corporate Headquarters Business Address

City

PRESIDENT/MGR/MEMBER/PARTNER:

Last Name

Date of Birth

FL DL/ID# (if other proof of ID is used, attach copy)

State

Zip Code

First Name and Middle Initial

(FRVIS Customer No.-Office Use)

Home Phone Number w/ Area Code

Daytime Phone Number w/ Area Code

Residence Address

City

VICE PRESIDENT/MGR/MEMBER/PARTNER:

Last Name

Date of Birth

FL DL/ID# (if other proof of ID is used, attach copy)

State First Name

Home Phone Number

Zip Code

(Fingerprint date-Office Use Only)

Middle Initial (FRVIS Customer No. ? Office Use) Daytime Phone Number w/ Area Code

Residence Address

City

SECRETARY/MGR/MEMBER/PARTNER:

Last Name

State First Name

Zip Code (Fingerprint date-Office Use Middle Initial (FRVIS Customer No. ? Office Use)

Date of Birth

FL DL/ID# (if other proof of ID is used, attach copy) Home Phone Number w/ Area Code

Daytime Phone Number w/ Area Code

Residence Address

City

TREASURER/MGR/MEMBER/PARTNER:

Last Name

State First Name

Zip Code

(Fingerprint date-Office Use

Middle Initial (FRVIS Customer No. ? Office Use)

Date of Birth

FL DL/ID# (if other proof of ID is used, attach copy) Home Phone Number w/ Area Code

Daytime Phone Number w/ Area Code

Residence Address

City

DIRECTOR/MGR/MEMBER/PARTNER:

Last Name

Date of Birth

FL DL/ID# (if other proof of ID is used, attach copy)

State

Zip Code (Fingerprint date-Office Use) Only)

First Name

Middle Initial (FRVIS Customer No. ? Office Use)

Home Phone Number w/ Area Code

Daytime Phone Number w/ Area Code

Residence Address HSMV 86056 Rev. 9/21

City

State

2

Zip Code (Fingerprint date-Office Use Only)

Please use a separate sheet if necessary.

APPLICATION FOR A LICENSE AS A MOTOR VEHICLE, MOBILE HOME, OR RECREATIONAL VEHICLE DEALER

4. If the place of business is owned by applicant, date of acquisition: Enter "LEASED" in the space above, if it is a leased location.

Please attach the following items for an original application:

MMoonntthh//DDaayy//YYeeaarr

? A completed application form HSMV 86056 and $300 fee for motor vehicle dealers or $340 fee for mobile home or recreational vehicle dealers;

? Proof of identification/DL (see instruction guide for acceptable forms of identification); ? A true copy of property lease or proof of ownership; ? Proof of electronic fingerprints for each new officer from a FDLE authorized service provider. Each individual listed in

items 3 (A) and/or (B) on this form must be electronically fingerprinted on a state and federal level. A list of authorized service providers can be accessed at the FDLE website. ? Copy of dealer training course completion document;

? Original surety bond/irrevocable letter of credit (Division of Motorist Services forms only: on-line access at );

? Copy of business and/or fictitious name registration (on-line access at ); ? Copy of certification from the Division of Corporations showing current registration of business to conduct business in

the State of Florida (on-line access at ); ? Corporation papers, corporate meeting minutes showing the election of corporate directors, Article of Incorporation if

the dealership is a Corporation or Incorporation; Articles of Organization and Operating Agreement if the dealership is a Limited Liability Company; or a Partnership Agreement if the dealership is a Partnership; and ? Independent dealers (VI), Auction dealers (VA), and Wholesale dealers (VW) have the option to submit a copy of:

o A garage liability insurance certificate which shall include, at a minimum, $25,000 combined single-limit liability coverage including bodily injury and property damage protection and $10,000 personal injury protection; OR

o A general liability insurance policy coupled with a business automobile policy, which shall included, at a minimum, $25,000 combined single-limit liability coverage including bodily injury and property damage protection and $10,000 personal injury.

o All garage/general liability insurance certificates must include the number of dealer license plates authorized for the dealership by the insurance company.

? Salvage dealers (SD) are exempt from submitting a garage liability insurance coverage. ? Mobile Home Dealers (DH) which sell park trailers are exempt from submitting garage liability insurance coverage. ? Franchise dealers (VF), Recreational dealers (RV & RU), and Mobile Home dealers (DH) selling recreational vehicles

must submit a garage liability insurance certificate which shall include, at a minimum, $25,000 combined single-limit liability coverage including bodily injury and property damage protection and $10,000 personal injury protection and the authorized number of dealer license plates.

Please attach the following items for a corporate update: ? A complete application form HSMV 86056; ? Minutes of the meeting; ? Proof of electronic fingerprints for each new officer from a FDLE authorized service provider. Each individual listed in items

3 (A) and/or (B) on this form must be electronically fingerprinted on a state and federal level. Access list at the FDLE website.

? Copy of the corporate changes registration from the Division of Corporations (on-line access at ). For additional information, please refer to the Dealer License Instruction Booklet. CERTIFICATIONS/STATEMENTS

Florida law requires applicants for various dealer licenses to provide certification or statements on a variety of issues. Please carefully read, complete, sign and date applicable certifications and statements.

Required of Motor Vehicle Dealer License Applicants

I certify that my business location provides an adequately equipped office and is not a residence; that the location affords sufficient unoccupied space upon and within which adequately store all motor vehicles offered and displayed for sale; and that the location is a suitable place where I can in good faith carry on such business to maintain books, records, and files necessary to conduct such business, which will be available at all reasonable hours for inspection by the department or any of its inspectors or employees. I further certify that the business of a motor vehicle dealer is the principal business which shall be conducted at the location.

Officer's Signature-Original Signature Required

HSMV 86056 Rev. 9/21

3

Date

APPLICATION FOR A LICENSE AS A MOTOR VEHICLE, MOBILE HOME, OR RECREATIONAL VEHICLE DEALER

Required of Mobile Home and Recreational Vehicle Dealer License Applicants:

I certify that my business location is a permanent one, not a tent or a temporary stand or other temporary quarters; and, except in the case of a mobile home broker, that the location affords sufficient unoccupied space to store all mobile homes and recreational vehicles offered and displayed for sale; and that the location is a suitable place in which I can, in good faith, carry on business, maintain books, records, and files necessary to conduct such business, which will be available at all reasonable hours for inspection by the department compliance examiners, inspectors or other department employees. I understand that this does not preclude a licensed mobile home dealer from displaying and offering for sale mobile homes in a mobile home park. I further certify that the business of a mobile home or recreational vehicle dealer is the principal business which shall be conducted at the location unless I am a mobile home park operator licensed as a mobile home dealer.

I plan to sell recreational vehicles and understand the requirement to obtain Garage Liability Insurance.

I plan to sell park models and understand there is no requirement to obtain Garage Liability Insurance. (DH ONLY)

Officer's Signature-Original Signature Required

Date

If no Federal Employer's Identification Number is obtained, the following statement is required of the applicant:

The individual owner(s) of the dealership is/are performing all duties in the business. There are no employees in the dealership.

Officer's Signature-Original Signature Required

Date

Required of Recreational Vehicle Dealer License Applicants:

As an applicant for a recreational vehicle dealer license, issued pursuant to Section 320.771, Florida Statutes, I have not and will not enter into any agreement, written or oral, with any other person or business entity, which would constitute an unfair and deceptive trade practice in violation of Part II of Chapter 501, Florida Statutes.

Officer's Signature-Original Signature Required

Date

I/We hereby agree that all documents, orders, notices or related correspondence will be served by e-mail at the e-mail address provided. I/We agree to add dealerservices@ as a contact so that email from the Division of Motorist Services is not classified as junk mail. If no e-mail address is provided, all documents shall be served by First Class U.S. Mail.

Officer's Signature-Original Signature Required

HSMV 86056 Rev. 9/21

4

Date

APPLICATION FOR A LICENSE AS A MOTOR VEHICLE, MOBILE HOME, OR RECREATIONAL VEHICLE DEALER

CERTIFICATION

(Must be completed by all dealership officers.)

5. Has this applicant, partner, corporate officer or director:

YES

NO Been convicted of a felony or equivalent charge anywhere?

YES

NO Been convicted of a felony or first degree misdemeanor for a violation of any provision

of Chapter 319 or 320, Florida Statutes?

YES

NO Been convicted of a felony or first degree misdemeanor in any other jurisdiction for

violation of motor vehicle laws (excluding parking and traffic laws)?

YES

NO Now facing criminal charges anywhere?

YES

NO Been denied a surety bond?

YES

NO Ever had a surety bond cancelled?

YES

NO Been a licensed dealer in Florida or any other jurisdiction?

State:

License #:

YES

NO Been denied or had dealer license suspended or revoked in Florida or any other

jurisdiction?

(IF THE ANSWER TO ANY PART OF QUESTION #5 IS "YES", APPLICANT IS REQUIRED TO SUPPLY APPROPRIATE DOCUMENTATION. IN THE CASE OF A FELONY CONVICTION, CHARGING DOCUMENTS AND DISPOSITION DOCUMENTS FROM THE COURT MUST ACCOMPANY THIS APPLICATION.)

Under penalty of perjury, I do swear and affirm that the information contained in this application is true and correct and that applicant, if licensed, will abide by all laws of Florida, including Chapters 319 and 320, Florida Statutes, and all applicable rules, policies, and procedures of the Department of Highway Safety and Motor Vehicles.

I further certify that I am authorized to bind the application with my signature.

I understand that I must meet all zoning requirements and occupational license requirements that may be mandated by local or county ordinances.

Signature-Original Signature Required

STATE OF COUNTY OF

Typed Name/Title NOTARIAL CERTIFICATE

Date

The attached instrument was acknowledged before me on this date, / _/ by Mr./Mrs./Ms. _who is personally known to me or who has produced as identification and who did take an oath.

(Seal)

(Notary)

(Signature of Notary) (Name of Notary, typed, printed or stamped)

(Title) (Commission Serial Number)

Important: This certification is required for each officer of the dealership. If necessary, please make copies of this page. After completing this certification for each officer, attach each copy to this application. Each certification must be notarized.

HSMV 86056 Rev. 9/21

5

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