Mv2186 Form – Fill Out and Use This PDF

MOTOR VEHICLE DEALER

Wisconsin Department of Transportation

TWO YEAR LICENSE APPLICATION

Dealer and Agent Section

FOR OFFICE USE ONLY

P.O. Box 7909

MV2186

2/2008

Ch. 218 Wis. Stats.

Issued

Expires

Madison, WI 53707-7909

Submit in duplicate.

Amending Current

License Information

Legal Name

Area Code - Telephone Number

Dealer License Number

Trade Name(s) or DBAs

Federal Employer Identification Number

Street Address or RFD

Post Office Box Number

City

State

ZIP Code

County where business located

Type of Vehicles to be Sold

Business Entity

If Corporation or LLC,

City

Village

Township

Autos

NEVs

Sole Proprietorship

Association

Date Licensed in Wisconsin

Name:

Trucks

(Neighborhood Electric Vehicles)

Partnership

Corporation

State of Incorporation or Organization

Motorcycles

LLC

List makes of new vehicles to be sold

E-mail Address

Address of NONADJACENT Sales Location in SAME MUNICIPALITY

Branch:

Sublot:

Was there a licensed dealer at this same location previously this year?

Do you own and operate your own service department?

No

Yes, Name dealer ________________________________________

Yes

No, Attach completed service agreement

Have you, as an individual and your above-named firm, been licensed as a dealer before?

Complete ONE of the following (whichever applicable):

YES

NO

Is business real estate owned by:

No

Yes, Same location?

No

Yes

Owner of sole proprietorship

If no,

Has your motor vehicle dealer license ever been denied, suspended or revoked?

One partner of partnership

send copy

No

Yes, When and what state? _________________________________

of lease.

Corporate dealership

Are you licensed as a motor vehicle salvage dealer at same location?

No

Yes, Give license number __________________________________

LLC

Number of

New AUTOS

Used

New

TRUCKS Used

New MOTORCYCLES Used

New

OTHERS (specify) Used

SALES TAX

vehicles sold

SELLER PERMIT NUMBER

Retail

in last 12

month period

Wholesale

Please check only ONE box that applies to your dealership.

Dealer License (Required fee)..................................$40.00

Call 608-261-9555 if you have questions about these fees.

Branch License

$40.00

1. During the next two years our dealership will sell all vehicles

Sublot License

$2.00

on a cash only basis. Fee due is $20.

Salesperson License(s)

Number _________ x $8.00

2. Our dealership originates retail installment sales contracts

and/or consumer leases.

(If test required, pay examiner)

a. All of the contracts or leases we originate are sold or

Wisconsin Buyer's License(s)

Number ____ x $12.00

transferred to a third party. Fee due is $100.

Buyer ID Card(s)

Number __________ x $12.00

b. Some or all of the contracts or leases are retained by

our dealership. Fee due is $100.

Dealer License Plates Required

First 2 plates = $150.00

3. The total amount of installment contracts and/or consumer

Number of additional plates ________________ @ $10.00

leases originated and retained in the last 12 months was

List letters of all missing plates

$ ________ , which is $100,000 or less. Fee due is $100.

4. The total amount of installment contracts and/orconsumer

Replacement License Plates for lost, damaged,

leases) originated and retained in the last 12 months was

$ ________ , which is greater than $100,000. Do not

or illegible plates

each plate $2.00

submit a fee. You will receive a separate bill.

Does your dealership write credit insurance?

No

Yes

CHECK PAYABLE TO: REGISTRATION FEE TRUST $

CHECK PAYABLE TO: Department of Financial Institutions

See reverse side.

X

(Authorized Dealership Agent, Title)

(Date)

X

(Print Name)

(Signature)

(Official Title)

(Municipality)

X

(Print Name)

(Signature)

(Official Title)

(Municipality)

X

(Print Name)

(Signature)

(Official Title)

(County)