Free MV2131 - Wisconsin

MANUFACTURER/IMPORTER/DISTRIBUTOR CERTIFICATION OF DEALER
MV2131 3/2005 Ch. 218 Wis. Stats.
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Wisconsin Department of Transportation Dealer Section PO Box 7909 Madison, WI 53707-7909

Dealer - Full Name

Address

City

State

ZIP Code

Manufacturer/Importer/Distributor Name ZIP Code

Address

City

State

Authorized Agent - Print Name/Position

Authorized Agent Office Address

Motor Vehicle Make

Contract Effective Date

Assigned Sales Locality - Name or Describe

Please check the box that applies: This dealership is NOT establishing, relocating or reopening at a location within the relevant market area of existing enfranchised dealers. Relevant market area is defined in s.218.0101(30) Wis. Stats. This dealership is establishing, relocating or reopening at a location within the relevant market area of existing enfranchised dealers and proper written notice of intent to enter into this franchise agreement has been made to the department and to each such existing enfranchised dealer as required by s.218.0116(7) Wis. Stats. (Attach copy of notice.) Please check the box that applies: A copy of the contract, including specific dealer delivery and preparation obligations is attached for filing as required by law. A blanket contract, including specific dealer delivery and preparation obligations has been or is filed as required by law. All our contracts with all Wisconsin dealers are identical.

I certify that the identified dealer and manufacturer/importer/distributor have executed a contract effective on the date specified, subject to the licensing provisions of Chapter 218, Wisconsin Statutes, for the representation and sales of the indicated make of motor vehicles in the listed community(ies) or territory(ies) within Wisconsin.

X

(Authorized Agent)

(Date)

NOTE: In case of contract termination/cancellation, Wisconsin Statutes require that written notice be given the dealer, including the effective date and specific grounds for termination or cancellation, at least 60 days prior to the effective date and that a copy of the notice be filed with the Department of Transportation. Manufacturer and distributor responsibilities, when franchising Wisconsin motor vehicle dealers, are included in Wisconsin Statute Chapter 218.