Form 5092 - Application For Online Dealer'S Monthly Sales Report Filing

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MISSOURI DEPARTMENT OF REVENUE

Reset

MOTOR VEHICLE BUREAU

PO BOX 43, JEFFERSON CITY MO 65105-0043

FORM

(573) 526-3669

5092

APPLICATION FOR ONLINE DEALER’S

MONTHLY SALES REPORT FILING

(REV. 11-2005)

SECTION A — APPLICATION TYPE — CHECK ONE BOX

DEALER TYPE — CHECK ONE BOX

NEW

CHANGE

CANCEL

MOTOR VEHICLE

BOAT

BOTH

WHOLESALE

SECTION B — SALES REPORTING OPTIONS — CHECK ONLY ONE OPTION

All sales must be filed monthly (or more frequently as determined by the dealer).

File sales using the Internet Notice of Sale Reporting System. Sales are filed one at a time. Requirements include access to the Internet, an e-mail ad-

dress, and the latest version of Internet Explorer or Netscape Navigator.

File sales by Hypertext Transfer/Protocol (HTTPS) using dealer’s current front-end software. Requirements include a file created by your software vendor

in the format prescribed by the department, access to the Internet, an e-mail address, and the latest version of Internet Explorer or Netscape Navigator.

List software vendor and e-mail address: _________________________________________________________________________________

SECTION C — DEALERSHIP AND CONTACT PERSON INFORMATION — PLEASE TYPE OR PRINT USING A BALL POINT PEN.

DEALERSHIP

CONTACT PERSON

NAME OF DEALERSHIP

CONTACT PERSON’S NAME (LAST, FIRST, MIDDLE)

DEALERSHIP’S ADDRESS (STREET, RR, OR PO BOX NUMBER)

CONTACT PERSON’S ADDRESS (STREET, RR, OR PO BOX NUMBER)

CITY

STATE

ZIP CODE

CITY