Form 5459 - Application For Online Dealer'S Temporary Registration Permit Processing
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Missouri Department of Revenue
Application for Online Dealer’s
Form
5459
Temporary Registration Permit Processing
Complete this application to gain access to the Department of Revenue’s Online Dealer’s Temporary Registration Permit
Processing system. Once the Department receives your application, an e-mail confirmation will be sent, along with your
password to access the system. To use the temporary registration permit application you must have the most current version
of Internet Explorer and Adobe Flashplayer. A laserjet printer will be required to print the temporary registration permits.
The Account Administrator you assign below will be responsible for adding, deleting, and modifying users in the temporary
registration permit system and resetting a user’s password when necessary.
Application Type (select only one box)
r
r
r
New
Change
Cancel
Dealership Information
Name of Dealership
Dealership’s Address (Street, RR, or PO Box number)
City
State
Zip Code
Motor Vehicle Dealer Number
If you like to associate multiple dealerships under one account, please list the names and dealer numbers for each dealership below.
Account Administrator Information
Account Administrator’s Name (last, first, middle)
Account Administrator’s E-mail Address
Account Administrator’s Telephone Number
User Name (Must be a minimum of 15 characters and contain 1 upper and 1 lower case letter)
(___ ___ ___) ___ ___ ___ - ___ ___ ___ ___
Under penalties of perjury, I declare that the above information and any attached supplemental documentation is true,
complete, and correct.
Signature of Dealership Owner or Agent
Printed Name of Dealership Owner or Agent
Title
Date (MM/DD/YYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
Form 5459 (Revised 05-2013)
Mail to:
Phone: (573) 526-3669
Visit dor.mo.gov
Motor Vehicle Bureau
PO Box 43
Fax: (573) 522-4197
for additional information.
E-mail: dealerlic@dor.mo.gov
Jefferson City, MO 65105-0043
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