Application For Act 539 Regulatory License Form - Alabama
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1
2For Office Use Only
LIC: 539-3
Rev. 7/08
A
D
R
LABAMA
EPARTMENT OF
EVENUE
S
, U
& B
T
D
ALES
SE
USINESS
AX
IVISION
Reset
S
& L
S
EVERANCE
ICENSE
ECTION
P.O. Box 327550 • Montgomery, AL 36132-7550 • (334) 353-7827
New
Renewal
Application for Act 539 Regulatory License
October 1, 2008 through September 30, 2009
_______________________
Applying For:
County
Check Appropriate Box(es)
}
Franchised New Motor Vehicle Dealer . . . . . . .
Motor Vehicle Reconditioner . . . . . . .
. . . . $10.00
. . . . $10.00
– or –
Used Motor Vehicle Dealer (Retail) . . . . . . . . . .
Motor Vehicle Rebuilder . . . . . . . . . . .
. . . . $10.00
Extra Locations ($5.00 each) . . . . . . . . . . . . . . . . . . $____________
Motor Vehicle Wholesaler . . . . . . . . . .
. . . . $10.00
Total Enclosed With Application . . . . . . . . . . . . . . $____________
Worthless Checks Will Result In License Revocation
For
{
Manufacturer:_____________________________________ Line Make:__________________________________
New Car
Dealers
Manufacturer:_____________________________________ Line Make:__________________________________
ONLY!
Manufacturer:_____________________________________ Line Make:__________________________________
Manufacturer:_____________________________________ Line Make:__________________________________
1.
________________________________________________________________________________________________________
LEGAL NAME OF BUSINESS
DBA NAME
________________________________________________________________________________________________________
MAILING ADDRESS
CITY
STATE
ZIP
________________________________________ ___________________________________ __________________________
STATE SALES TAX NUMBER (RETAIL ONLY)
FEDERAL EMPLOYER ID NUMBER
DATE BUSINESS BEGAN
2. Form of Organization:
Individual
Partnership
Limited Liability Company
Corporation
Provide the information below for owner, ALL partners, members, officers and directors. Attach additional sheet(s) if
necessary.
NAME
SOCIAL SECURITY NO.
HOME ADDRESS & CITY
HOME PHONE
A. _________________________________ ____ /___ /______ ___________________________________ (____)____________
B. _________________________________ ____ /___ /______ ___________________________________ (____)____________
C. _________________________________ ____ /___ /______ ___________________________________ (____)____________
D. _________________________________ ____ /___ /______ ___________________________________ (____)____________
3. List exact permanent location(s):
ADDRESS
CITY
ZIP
TELEPHONE
(VERIFIABLE LANDLINE)
NO CELLULAR PHONES
Primary Location ___________________________________________________________________________ (____)____________
Second Location ___________________________________________________________________________ (____)____________
Third Location _____________________________________________________________________________ (____)____________
For Office Use Only
4. Number of Motor Vehicles Sold January 1, 2007 through December 31, 2007:
RETAIL:
WHOLESALE:
Approved By: _____________________
New Vehicles
________________
________________
Bond Number: ___________________
W/I Date: _______________________
Used Vehicles
________________
________________
Entered By: ______________________
NOTE: Failure to provide all information will result in a delay of processing
Date: ___________________________
the application.
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