Form Lf021 - Application To Amend Independent Motor Vehicle Dealer'S License
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3Dealer & Licensees Form LF021
(512) 465-3000
(Rev. 2/13)
Toll-Free (888) 368-4689
Page 1 of 3
APPLICATION TO AMEND INDEPENDENT MOTOR VEHICLE DEALER’S LICENSE
GDN:
1.
INFORMATION AS IT CURRENTLY APPEARS ON YOUR LICENSE:
A. BUSINESS NAME:
ASSUMED NAME/DBA:
B. PHYSICAL ADDRESS:
CITY:
ZIP:
COUNTY:
C. MAILING ADDRESS:
CITY:
STATE:
ZIP:
FAX:
2. TELEPHONE NUMBER:
3. NEW INFORMATION (Fill in each blank or state "No Change")
A. NEW BUSINESS NAME OR ASSUMED NAME/DBA (If more than 1 license, complete form LF604):
B. MOVED TO NEW DEALERSHIP ADDRESS (NOTE: IF NEW LOCATION IS IN A DIFFERENT CITY THAN THE
CURRENT LICENSE, YOU MUST SUBMIT A NEW APPLICATION):
C. ADDED AN ADDITIONAL DEALERSHIP LOCATION (MUST BE IN SAME CITY AS CURRENT LICENSE):
D.
MAILING ADDRESS:
E.
NEW PHONE NUMBER, FAX NUMBER, OR EMAIL ADDRESS:
F. CHANGE FROM:
WHOLESALE TO RETAIL
RETAIL TO WHOLESALE
(see Page 2)
G.
OWNERSHIP CHANGE: (see Page 2 and complete Form LF601)
H.
CONVERSION FROM ONE ENTITY TO ANOTHER. (If more than 1 license, complete form LF604)
(see Page 3)
I.
OTHER (SPECIFY IN DETAIL):
4. ATTACH ALL REQUIRED DOCUMENTATION AND ANSWERS TO YES/NO QUESTIONS ON THE FOLLOWING PAGES
RELEVANT TO THE CHANGE(S) YOU ARE MAKING.
5. AMENDMENT FEE IS $25.00, PAYABLE TO TEXAS DEPARTMENT OF MOTOR VEHICLES. INCLUDE YOUR NAME OR
DBA ON THE CHECK /MONEY ORDER. COMPLETE ATTACHED FORM IF PAYING BY CREDIT CARD. IF PAYING BY
CREDIT CARD AN ADDITIONAL FEE OF $1.00 WILL BE ADDED.
6. MAIL THIS FORM AND ALL ATTACHMENTS TO:
PAYING BY CHECK/MONEY ORDER:
PAYING BY CREDIT CARD:
MOTOR VEHICLE DIVISION
MOTOR VEHICLE DIVISION
PO BOX 13044
PO BOX 2293
AUSTIN TX 78711-3044
AUSTIN TX 78768-2293
REMEMBER: MISSING, INCOMPLETE, OR INACCURATE INFORMATION MAY DELAY
PROCESSING OF YOUR AMENDMENT.
$25.00
RA
(NOTE: FEES ARE NON-REFUNDABLE)
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