Dmv Form Dsd 10 – Fill Out and Use This PDF

Each applicant must include a sample franchise agreement if doing business with more than one dealer (see Franchise Agreement Information on page 2). If applicant does not do business with more than one dealer, he/she may choose not to submit a sample franchise agreement but must include a statement acknowledging the applicant’s understanding that he/she must provide a sample franchise agreement upon doing business with more than one dealer.

Each distributor must include a copy of a distributor agreement with, or a parent letter from, the manufacturer or parent distributor authorizing the distribution of each vehicle line-make listed on the application.

APPLICATION TYPE

Authorized Changes: address change, name change, add/delete manufacturer or distributor, ownership change and relocation.

VEHICLE/BUSINESS TYPE

Vehicle Type

Business Type

MANUFACTURER - a person engaged in the business of constructing or assembling new motor vehicles and, in the case of trucks, also means a person engaged in the business of manufacturing engines, transmissions, power trains, or rear axles, when such engines, transmissions, power trains or rear axles are not warranted by the final manufacturer or assembler of the truck.

DISTRIBUTOR - a person who sells or distributes new motor vehicles pursuant to a written agreement with the manufacturer, to franchised motor vehicle dealers in the Commonwealth.

FACTORY/DISTRIBUTOR BRANCH - a branch office maintained by a person for the sale of motor vehicles to distributors or for sale of motor vehicles to motor vehicle dealers, or for directing or supervising, in whole or in part, its representatives in the Commonwealth.

BUSINESS INFORMATION

DSD 10 (07/28/2017)

Page 2

LINE-MAKE(S) AND FRANCHISE DEALER(S)

LIST LINE-MAKE(S) OF VEHICLE(S) TO BE SOLD IN THE COMMONWEALTH. DO NOT LIST MODELS AS LINE-MAKE(S) (attach additional sheets if necessary)

LIST APPLICANT'S FRANCHISE DEALER(S) (attach additional sheets if necessary)

OWNER/PARTNER/OFFICER INFORMATION

PRIVACY STATEMENT

In accordance with Virginia Code §§ 2.2-803, 2.2-4807 and § 58.1-520 et seq., the State Comptroller requires that this information, including your social security number, be collected for debt set off collection purposes.

CERTIFICATION

I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand that knowingly making a false statement or representation on this form is a criminal violation.

FRANCHISE AGREEMENT INFORMATION

A sample franchise agreement or sale, service or sales and service agreement refers to a manufacturers or distributors standard franchise agreement provided to all dealers that do not contain particularized terms, such as specific dealer's names, dealership address, dates or signatures of the parties.

Va. Code. 46.2-1569(9) requires that a franchise agreement contain the following language or words to the same effect:

If a provision herein contravenes the laws or regulations of any state or jurisdiction wherein this agreement is to be performed, or denies access to the procedures, forums, or remedies provided to such laws or regulations, such provision shall be deemed to be modified to conform to such laws or regulations, and all the other terms and provisions shall remain in full force, or words to that effect.

The above language, or words to the same effect, may appear in the main text or as an addendum to the franchise agreement. If an addendum is selected, the form must contain signature lines for the parties.