Free MV2184 - Wisconsin

SALESPERSON/REPRESENTATIVE LICENSE APPLICATION
Wisconsin Department of Transportation MV2184 8/2007 Ch. 218 Wis. Stats.

For DMV Office Use Only
Instruction on Page 2

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Exam Date

See instructions and fee schedule on reverse. Complete all sections of the application. Incomplete applications will not be processed; they will be returned to the employer. License Type - Check One
Motor Vehicle Salesperson
License Expiration Date Employer's Dealer License Number

Fees Collected $ PMR Number Service Center Badge Number

Recreational Vehicle Salesperson Manufacturer/Distributor Representative
Your Full Name Last

Fee Enclosed $
First

MI

Home Address - Street Number and Name or Rural Route Number ZIP Code E-Mail Address

City

State

Gender

Birth Date

Height

Weight State of License or ID

Eye Color

Hair Color

Female Male Driver License Number or Photo ID Number - If none, indicate "None"

Social Security Number - For Verification Purposes

Yes

No Have you been licensed as a salesperson in Wisconsin within the last 5 years? If yes, what year? __________________________
Dealer Name Dealer Number City

Was similar license ever denied, suspended or revoked in this or any other state? If yes, explain.

Have you ever been convicted of a crime? List all conviction(s) and date(s) of conviction(s).

Are any criminal charges pending against you? List all charge(s) and date(s) of arrest.

List any other names by which you are known.

Last

First

MI

Applicant Statement I, the undersigned, affirm under penalty of s.946.32 or s.345.17 Wisconsin Statutes, that the answers and statements on this application are true and correct. I understand that a misstatement on this application or any supporting documents might result in the denial, suspension or revocation of my salesperson or representative license under Ch. 218 Wisconsin Statutes. I authorize the department or its agent to verify this information.

X
(Applicant) (Date)

To Be Completed By Employer If this salesperson will work at more than one location, see special instructions for multiple dealerships on reverse.
Dealer/Manufacturer Name

Street Address

City, State, ZIP Code

I certify that I have reviewed the above information and request that the license be issued. I agree to give the applicant appropriate training BEFORE permitting him/her to transact business. I understand that I am responsible for the sales or representative practices of this employe and that his/her actions may be grounds for the denial, suspension or revocation of my business license.

X
Area Code - Telephone Number (Company Officer or Duly Authorized Agent) (Date)

(Title)

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Instructions

1. To avoid delays in processing, please complete the entire application. 2. Copy the ID Number from your driver license or photo identification card, exactly as it appears on the card. Include the state which issued the license or ID card. If you do not have a driver license or photo identification, indicate "NONE". 3. Answer all the yes/no questions; explain all "yes" answers. 4. Sign the application. 5. Have your employer complete the dealer information, including dealer license number and expiration date at the top of the form. Have the dealer/manufacturer statement signed. 6. See fee schedule below to determine fee. NOTE: An expired license CANNOT be transferred. 7. Submit the completed application and appropriate fee to: Wisconsin Department of Transportation Dealer and Agent Section, Room 201 PO Box 7909 Madison, WI 53707-7909 8. Salesperson exams are given at all DMV Service Centers (where you would go to renew your driver license). See the fee schedule below to determine whether an exam is required. Bring this form and fees with you to take the exam. 9. If you have questions, please call the Customer Service Unit at (608) 266-1425. Special Note for Multiple Dealerships Salespeople can be licensed at more than one dealership if all are under the same majority ownership. Only one license is required and should be issued at the location where the salesperson works most often. The license is valid at all other dealership locations.

FEE SCHEDULE - Make check payable to Registration Fee Trust

Motor Vehicle Salesperson License New application for motor vehicle salesperson license (Exam required) Currently licensed as a motor vehicle salesperson (Transfer - NOT expired) Not currently licensed as a motor vehicle salesperson License expired within the past 5 years (No exam required) Motor vehicle salesperson license expired more than 5 years (Exam required) Exam fee of $5.00 is included in fee schedule when required.

Dealer License Expires within 12 months

Dealer License Expires in MORE than 12 months

$9.00 No Fee $4.00 $9.00

$13.00 No Fee $8.00 $13.00

Manufacturer/Distributor Representative OR RV Salesperson License (NO Exam Required) New application for REP or RV sales Currently licensed as REP or RV sales (Transfer - NOT expired) Not currently licensed as REP or RV sales License expired within the past 5 years Not currently licensed as REP or RV sales License expired more than 5 years

Dealer License Expires within 12 months

Dealer License Expires in MORE than 12 months

$4.00 No Fee $4.00 $4.00

$8.00 No Fee $8.00 $8.00