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LICENSED MOTOR VEHICLE, MOBILE HOME, OR MODIFICATION TO (Florida)

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STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
PLEASE SUBMIT THIS APPLICATION TO THE REGIONAL OFFICE RESPONSIBLE FOR
YOUR DEALERSHIP
MODIFICATION TO DEALER LICENSE FOR
LICENSED MOTOR VEHICLE, MOBILE HOME, OR
Entered by:
RECREATIONAL VEHICLE DEALERS
Approved by:
Do not use white out or correction tape on this modification form.
Current License No.:
Licensee Name:
I hereby request the following modifications to my current dealer license:
(Please check and answer all application choices that apply)
PIN Number: Telephone Number: Office: Cell:
ETR Providers:
Business E-mail Address:
Recreational Vehicle Endorsement (DH License Only) Add Delete
New
RV Endorsement New and Used RV Endorsement Used RV Endorsement
Add Location: Used Vehicles Only New and Used Vehicles Selling RV
Selling Park Models
Physical Address:
Mailing Address:
Leased Owned Date:
Change of Location:
Old Address:
New Address:
Mailing Address:
Leased Owned Date:
Licensee Name Change d/b/a Name change
Former Name:
New Name:
Deleting Line-Make(s):
Adding Line-Make(s):
Existing Line-Make(s):
If you are adding or deleting line-make(s) from your license, please list all line-makes you are currently authorized to sell.
Change of Mailing Address:
Old Address:
New Address:
Change of Supplemental Location to Primary Location (where old primary location is closed)
Change of Supplemental Location to Primary Location and Change of Primary Location to
Supplemental Location (where primary and supplemental locations remain open)
New Primary Location Address:
New Supplemental Location Address:
Postal Address Update:
Under penalty of perjury, I do swear and affirm that the information contained in this application is true
and correct and that applicant will abide by all laws of Florida, including Chapters 319 and 320, Florida
Statutes, and all applicable rules, and procedures of the Department of Highway Safety and Motor Vehicles.
I further certify that I am authorized to bind the application with my signature.
Printed or Typed Name and Title Date
Officer’s Signature
HSMV 86072 (6/20)
Office Us
e Only
LICENSE
ISSUE DATE
DATE RECEIVED IN
REGIONAL OFFICE
DATE COMPLETED
IN REGIONAL
OFFICE
DATE MAILED TO
HEADQUARTERS
DATE RECEIVED IN
DEALER LICENSE
SECTION
AMOUNT
CHECK
CHECK NUMBER
CASH
CREDIT CARD
PAYMENT NUMBER
FRVIS CUSTOMER
NUMBER
SITE INSPECTION
NUMBER
Zone #:
Insp #:
Park Trailer Endorsement (DH License Only)
Add
Delete
click to sign
signature
click to edit
Completion Guidelines for Dealer License Applicants to
Modify Their Existing License, Form HSMV 86072
PLEASE SUBMIT THIS APPLICATION TO THE REGIONAL OFFICE RESPONSIBLE FOR YOUR DEALERSHIP
Modifications are requested only by dealers who are already licensed by the Department.
Correct modification box must be checked by the licensed applicant if they are submitting an
application to modify certain information on their license.
Do not use white out or correction tape on this form.
A copy of the driver license of a corporate officer of the dealership must be submitted with
the ap
plication for all modifications to a license. The following documents are required by
the Department for modifications to an existing license:
PIN REQUESTS
If a dealer’s confidential PIN number is lost, stolen or misplaced an officer or director of the
company will need to request a new confidential PIN number by selecting the PIN number
category.
• Complete form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
• A letter on letterhead from the dealership requesting the confidential PIN number
changed and why the change is needed.
• A Current copy of the Driver License of the person requesting the change.
There is no fee for this transaction. The confidential PIN number will be changed in the Dealer
License Section in Tallahassee. The confidential PIN number will then be mailed to the
applicant.
RECREATIONAL VEHICLE ENDORSEMENT
If an existing Mobile Home dealer requests to add or delete a new or used recreational vehicle
endorsement the following items are needed to complete the transaction. There is no fee for this
transaction.
NEW
• Complete form HSMV 86072, Modification to Dealer License for Licensed
Motor Vehicle, Mobile Home, or Recreational Vehicle Dealers;
• An agreement with the recreational vehicle manufacturer, importer, or distributor of the
models the dealer wants to sell.
USED
• Complete for HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
SUPPLEMENTAL LOCATION ESTABLISHMENT (Add Location)
Documents required for supplemental location establishment for a licensed independent
dealer (VI), wholesale dealer (VW), salvage dealer (SD) and auctions (VA):
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
True copy of lease agreement/proof of ownership or property tax;
•
A copy of the original Surety Bond, Irrevocable Letter of Credit, or an original
continuation certificate in the amount of $25,000 for the licensing period that was
submitted with the primary location;
•
A copy of the garage liability insurance certificate which shall include, at a minimum,
$25,000 combined single-limit liability coverage including bodily injury and property
damage protection and $10,000 personal injury protection; OR A general liability
insurance policy coupled with a business automobile policy, which shall include, at a
minimum, $25,000 combined single-limit liability coverage including bodily injury and
property damage protection and $10,000 personal injury protection that was submitted
with the primary location;
Please Note:
Salvage Dealers (SD) are exempt from Garage Liability Insurance
Requirements.
•
Surety Bond Rider (If the supplemental location has a new fictitious name);
•
Division of Corporations registration if a fictitious name is going to be added to the
supplemental location;
•
Fee $50 for the supplemental location. and
•
A copy of the driver license of a corporate officer of the dealership.
Documents required for supplemental location establishment for licensed Mobile Home
Dealers (DH), Mobile Home Brokers (BH), and Recreational Vehicle Dealers that sell Used
Recreational Vehicles (RU):
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
True copy of Lease agreement/proof of ownership or property tax;
•
Mobile home dealers must submit a copy of the original Surety Bond, Irrevocable Letter
of Credit, or an original continuation certificate in the amount of $25,000 for the
licensing period that was submitted with the primary location;
Please note: Mobile home dealers with more than four supplemental locations must
submit an original surety bond, original irrevocable letter of credit, or original
continuation certificate in the amount of $50,000;
Recreational Vehicle Dealers must submit copy of surety bond or original continuation
certificate in the amount of $10,000 for the licensing period that was
submitted with the
primary location with primary location.
Please Note: Recreational vehicle dealers with more than four supplemental locations
must submit an original surety bond or original continuation certificate in the amount of
$20,000;
•
Recreational vehicle dealers must submit a copy of the Garage Liability Certificate at a
min
imum of $25,000 combined single limit liability coverage including bodily injury and
property damage protection and $10,000 personal injury protection that was submitted
with
the primary location;
•
Mobile home dealers and mobile home brokers that sell recreatio
nal vehicles must submit
a co
py of the Garage Liability Certificate at a minimum of $25,000 combined single limit
liability coverage including bodily injury and property damage protection and $10,000
personal injury p
rotection that was submitted with the primary location;
•
Mobile Home dealers which sell park trailers are exempt from submitting garage liability
insurance coverage.
•
Surety Bond Rider (If the supplemental location has a new fictitious name);
•
Div
ision of Corporations registration if a fictitious name is going to be added to the
supplemental location;
•
Fee of $50 for the supplemental location. And
•
A copy of the driver license of a corporate officer of the d
ealership.
Documents required for supplemental location establishment for recreational vehicle
dealers that sell new Recreational Vehicles (RV):
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Manufacturers letter of approval if the supplemental location is going to sell new
recreational vehicles;
•
True copy of lease agreement/proof of ownership or property tax;
•
A copy of the original surety bond or an original continuation certificate in the amount of
$10,000 for the licensing period that was submitted with the primary location;
Please Note: Recreational vehicle dealers with more than four supplemental locations
must submit an original surety bond or original continuation certificate in the amount of
$20,000;
•
A copy of the Garage Liability Certificate at a minimum of $25,000 combined single
limit liability coverage including bodily injury and property damage protection and
$10,000 personal injury protection that was submitted with the primary location;
•
Surety Bond Rider (If the supplemental location has a new fictitious name);
•
Division of Corporations registration if a fictitious name is going to be added to the
supplemental location;
•
Fee of $50 for the supplemental location; and
•
A copy of the driver license of a corporate officer of the dealership.
PLEASE NOTE: Mobile home dealers with more than four supplemental locations must submit
an original surety bond, original irrevocable letter of credit, or original continuation certificate in
the amount of $50,000.
Recreational vehicle dealers with more than four supplemental locations must submit an original
surety bond or original continuation certificate in the amount of $20,000.
Documents required for supplemental location establishment for a licensed franchise
dealer (VF) if exemption(s) or no exemption(s) under section 320.642, Florida Statutes, is
claimed:
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Manufacturers letter of approval if the supplemental location is going to sell new line-
make(s);
•
Final order from the Department if the supplemental location is going to sell new line-
make(s);
•
True copy of Lease agreement/proof of ownership or property tax;
•
Fee of $50;
•
A copy of the original Surety Bond, Irrevocable Letter of Credit or an original
•
continuation certificate in the amount of $25,000 for the licensing period that was
submitted with the primary location;
•
A copy of the Garage Liability Certificate at a minimum of $25,000 combined single
limit liability coverage including bodily injury and property damage protection and
$10,000 personal injury protection that was submitted with the primary location;
•
Surety Bond Rider (If the supplemental location has a new fictitious name). and
•
A copy of the driver license of a corporate officer of the dealership.
CHANGE OF LOCATION
Documents required for change of location for a licensed independent dealer (VI),
wholesale dealer (VW), salvage dealer (SD) and auctions (VA):
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
A copy of the garage liability insurance certificate with the new address which shall
include, at a minimum, $25,000 combined single-limit liability coverage including bodily
injury and property damage protection and $10,000 personal injury protection; OR A
general liability insurance policy coupled with a business automobile policy, which shall
include, at a minimum, $25,000 combined single-limit liability coverage including bodily
injury and property damage protection and $10,000 personal injury protection that was
submitted with the primary location;
Please Note: Salvage Dealers (SD) are exempt from Garage Liability Insurance
Requirements.
•
True copy of lease agreement/proof of ownership or property tax;
•
Original license or affidavit from dealer if license is lost;
•
Fee of $50; and
•
A copy of the driver license of a corporate officer of the dealership.
Documents required for change of location for a licensed recreational vehicle dealer selling
new recreational vehicles (RV):
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Manufacturer’s approval letter;
•
A copy of the Garage Liability Certificate with the new address which shall include
at a minimum, $25,000 combined single limit liability coverage including bodily
injury and property damage protection and $10,000 personal injury protection that was
submitted with the primary location;
•
True copy of Lease agreement/proof of ownership or property tax;
•
Original License or affidavit from dealer if license is lost;
•
Fee of $25; and
•
A copy of the driver license of a corporate officer of the dealership.
Documents required for change of location for a licensed mobile home dealer (DH), mobile
home broker (BH) and recreational vehicle dealer selling used recreational vehicles (RU):
•
Co
mpleted form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Mobile home dealers and mobile home brokers that sell recreational vehicles must
submit a copy of the Garage Liability Certificate with the new address which shall
include at a minimum, $25,000 combined single limit liability coverage including
bodily injury and property damage protection and $10,000 personal injury protection
that was submitted with the primary location;
•
Mobile home dealers which sell park trailers are exempt from submitting garage
liability insurance coverage.
•
True copy of Lease agreement/proof of ownership or property tax;
•
Original License or affidavit from dealer if license is lost;
•
Fee of $25;
•
A copy
of the driver license of a corporate officer of the dealership.
Documents required for change of
location for a licensed franchise dealer (VF) if no
exemption under section 320.642, Florida Statutes, is claimed:
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Manufacturer’s approval letter;
•
A copy of the Garage Liability Certificate with the new address which shall include
at a minimum, $25,000 combined single limit liability coverage including bodily
injury and property damage protection and $10,000 personal injury protection that
was submitted with the primary location;
•
True copy of lease agreement/proof of ownership or property tax;
•
Original license or affidavit from dealer if license is lost;
•
Final order approving the relocation from the Department;
•
Fee of $50; and
•
A copy of the driver license of a corporate officer of the dealership.
Documents required for change of location for a licensed franchise dealer (VF) if
exemption under section 320.642(5)(a)1, 2, 3 or 4, Florida Statutes, is claimed:
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
A copy of the Garage Liability Certificate with the new address which shall include
at a minimum, $25,000 combined single limit liability coverage including bodily
injury and property damage protection and $10,000 personal injury protection that
was submitted with the primary location;
•
An affidavit on the dealership letterhead claiming an exemption under section
320.642(5)(a)1, 2, 3 or 4, Florida Statutes and FAC 15C-7.004;
•
True copy of lease agreement/proof of ownership or property tax;
•
Original license or affidavit from dealer if license is lost;
•
Fee$50; and
•
A copy of the driver license of a corporate officer of the dealership
•
Documents required for change of location as a result of buy/sell for a licensed franchise
dealer (VF) if no exemption under section 320.642, Florida Statutes, is claimed:
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Manufacturer’s approval letter;
•
A copy of the Garage Liability Certificate with the new address which shall include
at a minimum, $25,000 combined single limit liability coverage including bodily
injury and property damage protection and $10,000 personal injury protection that
was submitted with the primary location;
•
True copy of lease agreement/proof of ownership or property tax;
•
Original license or affidavit from dealer if license is lost;
•
Final order approving the relocation from the Department;
•
Fee of $50;
•
Voluntary Relinquishment of License form (VRL) completed by the selling dealer;
•
Buy/Sell Affidavit completed by the buying dealer;
•
Final order(s) from the Department approving the line make(s); and
•
A copy of the driver license of a corporate officer of the dealership.
Documents required for change of location as a result of buy/sell for a licensed
franchise dealer (VF) if exemption under section 320.642, Florida Statutes, is claimed:
•
Completed form HSMV 86072, Modification to Dealer License for Licensed
Motor Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Manufacturer’s approval letter;
•
A copy of the Garage Liability Certificate with the new address which shall include
at a minimum, $25,000 combined single limit liability coverage including bodily
injury and property damage protection and $10,000 personal injury protection that
was submitted with the primary location;
•
True copy of lease agreement/proof of ownership or property tax;
•
Original license or affidavit from dealer if license is lost;
•
Final order approving the relocation from the Department;
•
Fee of $50;
•
Voluntary Relinquishment of License form (VRL) completed by the selling dealer;
•
Buy/Sell Affidavit completed by the buying dealer; and
•
Final order(s) from the Department approving the line make(s).
•
A copy of the driver license of a corporate officer of the dealership.
NAME CHANGE
Documents required for change of name for a licensed independent dealer (VI), wholesale
dealers (VW), salvage dealers (SD), auctions (VA), mobile home dealers (DH), mobile
home brokers (BH) and recreational vehicle dealers that sell used recreational vehicles
(RU):
•
Co
mpleted form HSMV 86072, Modification to Dealer License for Licensed
Motor Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Surety Bond Rider;
•
A copy of the garage liability insurance certificate which shall include, at a minimum,
$25,000 combined single-limit liability coverage including bodily injury and property
damage protection and $10,000 personal injury protection; OR A general liability
insurance policy coupled with a business automobile policy, which shall include, at a
minimum, $25,000 combined single-limit liability coverage including bodily injury and
property damage protection and $10,000 personal injury protection that was submitted
with the primary location;
•
Mob
ile Home dealers (DH) which sell park trailers are exempt from submitting garage
liability insurance coverage.
Please Note:
Dealers
(SD) are exempt from Garage Liability Insurance Requirements.
•
Fictitious
Trade Name registration with the Division of Corporations. On-line access at
www.sunbiz.org
•
Licensee name change with the Division of Corporations. On-line access at
www.sunbiz.or;
•
Original license or affidavit from dealer if license is lost;
•
Affidavit from the dealer stating that the majority of the ownership of the dealership has
not changed;
•
Fee of $25 per name change; and
•
A cop
y of the driver license of a corporate officer of the dealership.
Docum
ents required for change of name for a licensed recreational vehicle dealer that
sell new recreational vehicles (RV):
•
Completed form HSMV 86072, Modification to Dealer License for Licensed
Motor Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Manufacturer’s letter of approval;
•
Surety Bond Rider;
•
A copy of the Garage Liability Certificate at a minimum of $25,000 combined
single limit liability coverage including bodily injury and property damage
protection and
$10,000 personal injury protection that was submitted with the primary location;
•
Fictitious Trade Name registration with the Division of Corporations. On-line access at
www.sunbiz.org;
•
Licensee name change with the Division of Corporations. On-line access at
www.sunbiz.org;
•
Original license or affidavit from dealer if license is lost;
•
Affidavit from the dealer stating that the majority of the ownership of the dealership has
not changed;
•
Fee of $25 per name change; and
•
A copy of the driver license of a corporate officer of the dealership.
Documents required for change of name for a licensed franchise dealer (VF) that sell new
vehicles:
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
A copy of the Garage Liability Certificate at a minimum of $25,000 combined single
limit liability coverage including bodily injury and property damage protection and
•
$10,000 personal injury protection that was submitted with the primary location;
•
Surety Bond Rider;
•
Fictitious Trade Name registration with the Division of Corporations. On-line access at
www.sunbiz.org;
•
Licensee name change with the Division of Corporations. On-line access at
www.sunbiz.org;
•
Manufacturer’s letter of approval;
•
Original license or affidavit from dealer if license is lost;
•
Affidavit from the dealer stating that the majority of the ownership of the dealership has
not changed and there has been no change in the signatories of the dealer sales and
service agreement;
•
Fee of $25 per name change; and
•
A copy of the driver license of a corporate officer of the dealership.
ADDING A FRANCHISE LINE-MAKE
Documents required for adding a franchise line-make:
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Manufacturers letter of approval for each line-make; and
•
Final Order from the Department.
•
A copy of the driver license of a corporate officer of the dealership.
NOTE: No fee is required to add a line-make.
DELETING A FRANCHISE LINE-MAKE
Documents required for deleting a Franchise:
•
Completed form HSMV 86072, Modification to Dealer License for Licensed Motor
Vehicle, Mobile Home, or Recreational Vehicle Dealers.
•
A copy of the driver license of a corporate officer of the dealership.
NOTE: No fee is required to delete a line-make.
MAILING ADDRESS CHANGE
Documents required for change of Mailing Address for all license categories:
•
Completed form HSMV 86072, Modification to Dealer License for
Licensed Motor Vehicle, Mobile Home, or Recreational Vehicle Dealers.
•
A copy of the driver license of a corporate officer of the dealership.
NOTE: No fee is required.
The mailing address can also be done at the time of renewal of the franchise dealer
license.
SUPPLEMENTAL TO MAIN/MAIN TO SUPPLEMENTAL
Documents required for change of supplemental location to main location/main location
to supplemental location for all license categories:
•
Completed form HSMV 86072, Modification to Dealer License for
Licensed Motor Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Original licenses of both the main and supplemental locations;
•
Affidavit from the dealer if license is lost; and
•
A copy of the driver license of a corporate officer of the dealership.
NOTE: No fee is required.
POSTAL UPDATE
Documents required for Postal Update for all categories of dealer licenses:
•
Completed form HSMV 86072, Modification to Dealer License for
Licensed Motor Vehicle, Mobile Home, or Recreational Vehicle Dealers;
•
Original License;
•
Affidavit from dealer if the original license is lost;
•
Letter from Postal Service/County/Municipality; and
•
A copy of the driver license of a corporate officer of the dealership.
NOTE: No fee is required.
Park Trailer Endorsement
Documents requirement to add or delete a park trailer endorsement for a
Mobile Home Dealer (DH) only
• Completed form HSMV 86072, Modification to Dealer License for
Licensed Motor Vehicle, Mobile Home, or Recreational Vehicle Dealers;
• Original License;
• Affidavit from dealer if the original license is lost;
• A copy of the driver license of a corporate officer of the dealership.
NOTE: No fee is required
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LICENSED MOTOR VEHICLE, MOBILE HOME, OR MODIFICATION TO (Florida)

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Completed 15 March 2022

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