Was there a licensed dealer at this same location previously this year?
If yes, Name dealer ____________________________________________
Have you, as an individual and your above-named rm, been licensed as a dealer before?
If yes, Same location? No Yes
Has your motor vehicle dealer license ever been denied, suspended or revoked?
If yes, When and what state? _____________________________________
Are you licensed as a motor vehicle dealer at same location?
If yes, Give license number _______________________________________
You must submit 2 letters from the WI Dept. of Natural Resources: One conrm-
ing your coverage under a storm water permit and a second conrming your reg-
istration with the refrigerant recovery program or that you have certied through
another refrigerant recovery compliance method.
Type 4 - Salvage does not need a storm water permit.
State ZIP Code
County where business located
(Authorized Dealership Agent, Title) (Date)
Legal Name
Dealer License Number
Area Code - Telephone Number
Trade Name(s) or DBAs
Type 1. Facilites include business oce on or adjacent to the salvage yard where motor vehicles are dismantled and/or stored.
Type 2. Facilities are provided and salvage business is conducted strictly within building, in which business oce is provided and motor vehicles
are stored and dismantled; there is no adjacent salvage yard.
Type 3. Facilities include business oce on or adjacent to the scrap metal recycling operation (shredder, baler, etc.) where salvage motor vehicles
and other scrap metal commodities are reduced in size for shipment to metal producing companies.
Type 4. Facilities do not include a salvage yard, but only a business oce for maintenance of required motor vehicle salvage records. Salvage
motor vehicles are purchased from vehicle owners and transported directly to salvage yards or scrap metal recyclers. The vehicle(s) used
for transporting salvage metals shall be parked and stored at the following location, which has been approved by local authorities:
Check one of the following statements, which properly explains the minimum type business facilities provided and the extent of this motor vehicle sal-
vage or recycling operation at main location. If you listed above an additional salvage business address within the same municipality, also check type of
facilities and operation for such additional location, below right.
Completely describe other business, if any, engaged in by your rm
Same location?
No Yes
Business Address Post Oce Box Number
Submit this application with completed Entity/Owner State-
ment, nancial statement on form enclosed and $150.00
two year license fee payable to: Registration Fee Trust.
Anticipated Date Business Facilities Will Be Ready
I, the undersigned, certify under penalty of s.946.32 or s.345.17 Wisconsin Stat-
utes, that the answers and statements on this application are true and correct to
the best of my knowledge.
Sole Proprietorship
Business Entity If Corporation or LLC,
Date Licensed in Wisconsin
Address of Additional Salvage or Recycling Location in Same Municipality, which conforms with local zoning requirement
See reverse side.
MV2180 10/2019 Ch. 218 Wis. Stats.
Wisconsin Department of Transportation
Dealer Section
PO Box 7909
Madison, WI 53707-7909
State of Incorporation or Organization
Is business real estate owned by:
Owner of sole proprietorship
One partner of partnership
Corporate dealership
If no,
send copy
of lease.
Amending Current License Information
Name and Title of Owner, Partners, Association Members, Corporation Ocers and Shareholders, LLC Managers and Members
Complete an Entity/Owner Statement (Form MV2844) for each individual listed.
Federal Employer Identication Number
Complete ONE of the following (whichever applicable):
E-mail Address
Business Type
Section A
1. Operation of the salvage business, type indicated above, at the location(s) stated above is in accordance with local
zoning, building code and permit requirements.
2. S.175.25 Wisconsin Statutes, requires a permit be issued by (1) the common council or village board, if the
salvage yard is located within the corporate limits of any city or village, OR (2) the town board, if the salvage yard
is located within 2,000 feet outside the corporate limits of a city or village, or within 750 feet of the center line
of any county trunk, state trunk or federal highway, or within 500 feet of the center line of any town road.
Check one box and sign below:
Following Applies To First-time Dealer Applicant Or Application For Amended License
Because of Business Relocation or Ownership Change
Proper local ocials must sign below, BEFORE submitting this application. All applicants complete section A.
If business is located in a township, complete both sections A and B.
Attention Zoning Authorities: See front of application for type of salvage operation being conducted.
Section B
County Zoning Approval - required only if business is located in a township.
Operation of the salvage business, type indicated above, at the location(s) stated above is in accordance with local
zoning regulation.
(Signature)(Print Name)
(Ocial Title)
A local permit or license is required and has been issued.
A local permit or license is not required.
(Signature)(Print Name)
(Ocial Title)
(Signature)(Print Name)
(Ocial Title)
Business Type
If business address on front does not include a specic street number, furnish directions to your business location, includ-
ing highway numbers or letters and distances.
Business Name / Location
Business Name / Location
Business Type