Form R-1393 - Resale Certificate Application For Used Vehicle Dealer Purchases Of Parts And Services

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R-1393 (1/11)
Resale Certificate Application for Used Vehicle Dealer
Purchases of Parts and Services
Louisiana Department of Revenue
Special Programs Division
P.O. Box 66362
Baton Rouge, LA 70821-6362
Telephone: (225) 219-7462 • TDD: (225) 219-2114
Fax: (225) 231-6236
Questions about the completion of this application should be sent to Sales.
Inquires@LA.GOV.
This application must be submitted with a copy of the applicant’s current Louisiana Recreational and Used Motor Vehicle and
Parts Commission license.
PLEASE PRINT OR TYPE.
Used Motor Vehicle Dealer Legal Name
Louisiana Sales Tax Account Number
(if applicable)
Motor Vehicle Dealer Trade Name
Louisiana Recreational and Used Motor Vehicle and Parts Commission license number
License expiration date
Dealer Location
City
State
ZIP
Dealer Mailing Address
City
State
ZIP
I hereby certify that the business listed above is a used motor vehicle dealer and is duly licensed by the Louisiana Recreational and Used
Motor Vehicle and Parts Commission.
Authorized Name
Title
(please print)
Authorized Signature
Date
(mm/dd/yyyy)

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