MOTOR VEHICLE SALES FINANCE ACT
INSTALLMENT SELLER
LICENSE APPLICATION INSTRUCTIONS (FIS 1028)
The Director of the Department of Insurance and Financial Services has determined that this application is available for public inspection or copying pursuant to the provisions of the Freedom of Information Act, PA 442 of 1976, MCL 15.231 et seq.; and section 2109 of the Michigan Banking Code of 1999, as amended, MCL 487.12109. Accordingly, except as otherwise indicated in this application, the contents of the application shall be disclosed to any person who properly requests an opportunity for inspection, examination, or copying.
GENERAL INSTRUCTIONS
1.The application for a license must be made in writing (printed in ink or typed) to the Director of the Department of Insurance and Financial Services (DIFS) on the attached forms. If, after investigation, the Director determines that the experience, character, business reputation, and general fitness of the applicant and its officers, directors, shareholders, partners, members, and affiliates command the confidence of the public and warrant belief that the applicant and its officers, directors, shareholders, partners, members, and affiliates will comply with the law, and that grounds for revoking, suspending, or denying a license pursuant to the Act do not exist, the Director will issue the license.
2.DIFS will not accept an incomplete application. Complete responses to all questions will expedite the processing of the application. Do not leave any question blank. Enter “N/A” or “None” if not applicable. An application will not be accepted if it contains whiteout or strikeouts.
3.The application must contain original signatures, where applicable.
4.The full legal business name as well as DBAs (if applicable) must be used throughout the application. These names must match what is approved with the Michigan Corporations Division or your local county clerk’s office (including commas, periods, etc.)
5.Installment sale contracts are not required to be submitted with the installment seller application. Consult your legal counsel regarding contract compliance with the Act.
6.Notice to Notaries:
a.The county where the notary is authorized to sign and the county where the document was executed must match.
7.Mail the completed application to:
Mail Delivery Address: |
Overnight Delivery Address (UPS or FedEX): |
DIFS-Consumer Finance Licensing Unit DIFS-Consumer Finance Licensing Unit |
PO Box 30220 |
530 W. Allegan St., 7th Floor |
Lansing, MI 48909 |
Lansing, MI 48933 |
QUESTIONS: For assistance in completing this application, please contact the Consumer Finance Licensing Unit at 877-999-6442.
APPLICATION AND ACCOMPANYING DOCUMENTS
All Installment Seller Applicants:
Complete pages 1 and 2 of the application.
Submit copy of Michigan dealer license issued by the Bureau of Regulatory Services 888-767-6424. (Note: Include your Michigan dealer license number on page 1 of the application.)
Complete the Confidential Background Consent Form (page 7 of application) only if a “Yes” response is given to the crime question on page 2 of the application. The confidential background consent form is to be completed only by the individual(s) who provided a “yes” response.
Submit $30.00 application fee. Make check payable to “State of Michigan.”
The following definitions apply to page 2 of the application:
•Officers include, but are not limited to, Chief Executive Officer, President, Executive or Senior Vice Presidents, Secretary, Treasurer, Chief Financial Officer, Chief Operating Officer, and Chief Compliance Officer.
•Directors include all members of the Board of Directors of a corporation, Board of Trustees, Executive Committee, and any other governing body.
•Shareholders include all owners. If applicant is a publicly traded company subject to SEC jurisdiction and filing requirements, list only those shareholders that control, directly or indirectly, 10% or more of the applicant’s outstanding voting stock.
•Members include all members if applicant is organized as a limited liability company.
IN ADDITION TO THE ABOVE REQUIREMENTS, COMPLETE AS APPLICABLE: Individuals Doing Business Under Own Name:
Complete page 5 of application – Affidavit of Official Signing of Application (check box “Individual”)
Individual Doing Business Under an Assumed Name/Trade Name:
Complete page 5 of application – Affidavit of Official Signing of Application (check box “Individual”)
Provide copy of DBA certificate issued by the county clerk’s office
Corporation:
Complete page 3 of application – Certificate of Resolution-Corporate Board of Directors
Complete page 5 of application – Affidavit of Official Signing of Application (check box “Corporation”)
Complete page 6 of application – Power of Attorney
General Partnership:
Complete page 5 of application – Affidavit of Official Signing of Application (check box “Partnership”)
Provide copy of DBA certificate issued by the county clerk’s office
Limited Partnership:
Complete page 5 of application – Affidavit of Official Signing of Application (check box “Partnership”)
Register with the Department of Licensing and Regulatory Affairs, Corporations, Securities & Commercial Licensing Bureau 1-517-241-6470. (Note: The full legal name registered (including commas, periods, etc.) and DBAs, if applicable, must be stated throughout the application.
Limited Liability Company:
Complete page 4 of application – Certificate of Resolution
Complete page 5 of application – Affidavit of Official Signing of Application (check box “Limited Liability Company”)
Complete page 6 of application – Power of Attorney
Full Legal Business Name
FIS 1028 (12/18) Department of Insurance and Financial Services Page 1 of 7
Motor Vehicle Sales Finance Act
INSTALLMENT SELLER License Application
**Please read and refer to the accompanying instructions before completing this application**
(Corporation, Limited Liability Company, Partnership, Sole Proprietorship, or Individual). Include DBAs, if applicable. Names must match what is approved with the Michigan Corporations Division or your local county clerk’s office (including commas, periods, etc.).
Physical Address
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Mailing Address (if different than above) |
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Applicant Contact Person |
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Website Address |
Federal Taxpayer I.D. Number |
Dealer License Number |
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Other place of business in the same city conducted under the name above, with all records being maintained at the above address.
STATUS OF APPLICANT: (Check appropriate box)
An Individual doing business under Assumed Name/ |
A Limited Partnership |
Trade Name/Own Name |
A General Partnership |
An Association |
Other – Describe: |
A Corporation (Put ID # below) |
A Limited Liability Company (Put ID # below) |
Michigan ID# |
Michigan ID # |
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1950 PA 27 requires submission of this form by applicants for a license to do business as an Installment Seller. Failure to complete and submit this form properly could result in denial, suspension or revocation of your license.
CONSUMER FINANCE OFFICE USE ONLY
Date Approved
Approved By
Date License Issued
License Number
FIS 1028 (12/18) Department of Insurance and Financial Services Page 2 of 7
List the names of all officers, directors, shareholders, members, and partners of the applicant. See Instructions for definitions.
Ownership MUST equal 100%. (If more space is required, please attach additional sheets as necessary.)
Residential Address (Street, City, State, ZIP Code)
YES NO
Has any individual of your organization ever been convicted of a crime? If yes, each individual who affirmatively answers this question must complete and submit the Confidential Background Consent Form (page 7 of the application) and attach a separate sheet disclosing the facts of the conviction(s). “Crime” includes a misdemeanor, felony, or a military offense. Exclude any misdemeanor traffic citations and misdemeanor juvenile offenses.
FIS 1028 (12/18) Department of Insurance and Financial Services Page 3 of 7
Certificate of Resolution
CORPORATE BOARD OF DIRECTORS (For corporate applicants only)
Resolution MUST be completed in applicant's full name, including DBA name(s), if applicable.
This is to certify that at a ______________________________ meeting of the Board of Directors of
Regular or Special
_______________________________________________________________________________,
Full Legal Business Name
a corporation organized under the laws of the State of __________________, and doing business
State
at __________________________________________________________________________,
Street AddressCityStateZIP Code
held at the office of said corporation on the _____________ day of ________________, ______, the
DateMonthYear
following resolution was duly and legally presented and adopted by majority vote of the Board, to wit:
It being the desire and purpose of the Board of Directors of:
______________________________________________________________________________
Full Legal Business Name
that this corporation should take steps to engage in the business of an installment seller,
under the provisions of Act No. 27 of the Public Acts of 1950, Extra Session, as amended.
BE IT RESOLVED, that ________________________________ as _______________________
Officer NameTitle
of this corporation, and in his/her official capacity is hereby authorized and directed to prepare, execute, verify, and present to the proper state authorities of the State of Michigan, and on behalf of the above named corporation, written application for license under as amended, authorizing the provisions of Act No. 27 of the Public Acts of 1950, Extra Session, as amended, authorizing the conducting of said business of an installment seller, by this corporation at
____________________________________________________________________________,
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ZIP Code |
and to do all acts and perform all necessary legal requirements on behalf of said corporation to
procure the same.
FIS 1028 (12/18) Department of Insurance and Financial Services Page 4 of 7
Certificate of Resolution
(For limited liability company applicants only)
Resolution MUST be completed in applicant's full name, including DBA name(s), if applicable.
This is to certify that at a ______________________________________ meeting of the Members of
Regular or Special
_______________________________________________________________________________,
Full Legal Business Name
a limited liability company organized under the laws of the State of __________________, and doing
State
business at ______________________________________________________________________,
Street AddressCityStateZIP Code
held at the office of said limited liability company on the ________ day of ____________, ________,
DateMonthYear
the following resolution was duly and legally presented and adopted by majority vote of the Board,
to wit: It being the desire and purpose of the Members of:
_______________________________________________________________________________,
Full Legal Business Name
that this limited liability company should take steps to engage in the business of an installment seller,
under the provisions of Act No. 27 of the Public Acts of 1950, Extra Session, as amended. BE IT RESOLVED, that
_______________________________________________ as ___________________________
Officer NameTitle
of this limited liability company, and in his/her official capacity is hereby authorized and directed to prepare, execute, verify, and present to the proper state authorities of the State of Michigan, and for and on behalf of the above named limited liability company, written application for license under the provisions of Act No. 27 of the Public Acts of 1950, Extra Session, as amended,
authorizing the conducting of said business of an installment seller this limited liability company at
____________________________________________________________________________,
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ZIP Code |
and to do all acts and perform all necessary legal requirements on behalf of said limited liability
company to procure the same.
FIS 1028 (12/18) Department of Insurance and Financial Services Page 5 of 7
Affidavit
Official Signing of Application
Please check as appropriate:
Individual
Corporation
Partnership
Limited Liability Company
I, ___________________________________________________________________________ of
Officer Name and Title
____________________________________________________________________________
Full Legal Business Name
do hereby declare that I am duly authorized to file the foregoing application and that the statements and representations set forth therein are true to the best of my knowledge and belief.
STATE OF (______________________________)
COUNTY OF (____________________________)*
Subscribed and sworn to before me, a Notary Public in and for said County, on this ____________
day of _________________, _______.
(NOTARY SEAL)
Notary Public
Printed Name of Notary Public
My Commission Expires
NOTICE TO NOTARIES:
*County where notary is authorized to sign and county where document is executed must match.
FIS 1028 (12/18) Department of Insurance and Financial Services Page 6 of 7
Power of Attorney (For Corporations and Limited Liability Companies only)
KNOW ALL PERSONS BY THESE PRESENT, THAT
_________________________________________________________________________________________________
Full Legal Business Name
organized under the laws of __________________________ and engaged in business in the State of
State
Michigan under the provisions of Act No. 27, Public Acts of 1950, Extra Session, as amended, constituted and appointed and by these presents, does make, constitute, and appoint ________________________________
Full Name (Must be a resident of Michigan)
_______________________________________________________________________________________ its true and
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lawful ATTORNEY or AUTHORIZED AGENT, for it and in its name, place, and stead, upon whom all lawful process in any proceedings against it may be served and agrees that service of process on its attorney or authorized agent herein named shall be of the same legal force and validity as if served upon it, the said corporation/limited liability company, and the authority for such service and process shall continue in force as long as any liability remains outstanding against it in the State of Michigan.
In case of death, removal from the State of Michigan or any legal disability or disqualification of its attorney or authorized agent herein named, the said corporation/limited liability company does hereby appoint the Director, Department of Insurance and Financial Services of the State of Michigan, and any successor in the office, to be its true and lawful attorney and authorized agent upon whom all lawful process in any proceeding against may be served and agrees that service of process upon the Director, Department of Insurance and Financial Services on shall be of the same legal force and validity as if served upon it, the said corporation/limited liability company, and the authority for such service and process shall continue in force as long as any liability remains outstanding against it in the State of Michigan.
IN WITNESS THEREOF the said corporation/limited liability company has caused these presents to be executed by its authorized officer, this ___________ day of ______________________, ____________.
Date
Authorized Signature
STATE OF (______________________________)
COUNTY OF (____________________________)*
Subscribed and sworn to before me, a Notary Public in and for said County, on this _____________
day of ______________________, __________.
(NOTARY SEAL) |
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My Commission Expires |
NOTICE TO NOTARIES: |
*County where notary is authorized to sign and county where document is executed must match. |
FIS 1028 (12/18) Department of Insurance and Financial Services Page 7 of 7
CONFIDENTIAL BACKGROUND CONSENT FORM
This form is required to be completed by any individual that answered “Yes” to crime question on Page 2 of the application.
By signing this Consent, I understand and agree to the following:
The information about me requested in the application is necessary to assist the Department of Insurance and Financial Services (DIFS) in evaluating the application of:
______________________________________________________________________________.
Full Legal Business Name
The information will be used to evaluate, among other things, my financial responsibility and general fitness as required by Section 8 of the Motor Vehicle Sales Finance Act.
Although submission of the information is voluntary, omissions or inaccuracies in completing the application may result in denial.
DIFS may also conduct an independent investigation of me, which may include but not be limited to, contacting federal and state law enforcement agencies, other governmental agencies, and credit reporting agencies. If any information the office receives indicates a violation of law, the information will be shared with any agency responsible for investigating or prosecuting the violation.
If information about me would warrant denial of the application, the office will give the application, through the person designated for contact, notice of that fact, including a statement of the statutory and factual basis which would warrant denial and the applicant’s rights in respect thereto.
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Other names by which I am now known or have used in the past. |
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