Form D72 - Change Of Record Form Page 2
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1
2 Add Owners:
If an owner is being deleted due to death please provide a copy of the death certificate.
If an owner is being deleted and transferring ownership to an existing member the Transfer of Ownership (D-23)
form is required.
If you are transferring the dealership to new owners a completed Transfer of Ownership (D-23) form is required, in
addition to a complete original application (D-17), all required documents and appropriate fees from the new
ownership.
To add owner(s) or corporate officers, the following information must be completed. When adding a partner 3 credit
references with complete addresses must be provided on the references business letterhead.
Sex: Male Female
SSN #
DOB
/
/
Driver’s License #
Owner Type: Officer
Partner
Individual
Member
Name
Last
First
Middle
Residence Address
Street
City
County
State
Zip
Residence Phone #
Cell Phone #
Sex: Male Female
SSN #
DOB
/
/
Driver’s License #
Owner Type: Officer
Partner
Individual
Member
Name
Last
First
Middle
Residence Address
Street
City
County
State
Zip
Residence Phone #
Cell Phone #
Sex: Male Female
SSN #
DOB
/
/
Driver’s License #
Owner Type: Officer
Partner
Individual
Member
Name
Last
First
Middle
Residence Address
Street
City
County
State
Zip
Residence Phone #
Cell Phone #
Sex: Male Female
SSN #
DOB
/
/
Driver’s License #
Owner Type: Officer
Partner
Individual
Member
Name
Last
First
Middle
Residence Address
Street
City
County
State
Zip
Residence Phone #
Cell Phone #
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