STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
NEIL KIRKMAN BUILDING, TALLAHASSEE, FLORIDA 32399-0500
RENEWAL APPLICATION
MOTOR VEHICLE, MOBILE HOME, OR RECREATIONAL VEHICLE DEALERS
ANNUAL RENEWAL BIENNIAL (TWO YEARS) RENEWAL
PLEASE SUBMIT THIS APPLICATION TO THE REGIONAL OFFICE RESPONSIBLE FOR YOUR DEALERSHIP
IF THERE ARE NO CHANGES FROM LAST YEAR, YOU MAY FILE THIS FORM TO RENEW YOUR LICENSE.
THIS FORM MAY ALSO BE USED FOR THE FOLLOWING:
Change of Mailing Address (Please Check Box if Mailing Address Needs Updating)
Do not use white-out or correction tape on this application.
Current or last License Number (Include suffix if Additional Location):
Licensee
Name:
Sole Proprietor
Corporation
Limited Liability Company/Partnership (LLC/LLP)
Limited Liability Limited Partnership (LLLP) Partnership
Fictitious (DBA) Name:
Dealership Physical Address:
Street Address
City County State
Zip Code
Mailing Address:
Enter Mailing Address Even if Same as Physical Address
OFFICE USE ONLY
Entered by
Approved by
City County State
Zip Code
Federal Employer’s Identification Number (FEID): _____________________________________
Florida Sales Tax Number:
Business
E-Mail Address:
Business
Telephone Number: ( ) Fax Number: ( )
Cell
Phone Number: ( )
Who is your ETR vendor?
GLI Company E-mail Address:______________________________________________________
Surety Bond Company E-mail Address:_______________________________________________
Proof of Identification, if Sole Proprietor or Partnership:
Acceptable Proof of Identification includes:
● A Florida driver license or identification card (please include number in appropriate space above);
● An out of state driver license or identification card;
● A US passport;
● A Canadian driver license, identification card, or passport;
● A driver license or identification card from any US Territory (American Samoa, Guam, Mariana,
Puerto Rico, and the US Virgin Islands); and
● An out of country passport.
A copy of the proof of identification must be submitted with your renewal form to the Department, unless the
proof of identification submitted is a Florida driver license or identification card (please include driver
license/identification number in appropriate space above).
COMPLETION OF THIS SECTION IS MANDATORY FOR PROCESSING:
Have you or any officer/owner been convicted of a felony or equivalent in any jurisdiction since your last
renewal?
Yes
No
If the answer is “Yes”, please submit the charging document(s) and disposition document(s).
I
HSMV 86720 (Rev 5/16) PLEASE SUBMIT THIS APPLICATION TO THE REGIONAL OFFICE FOR YOUR DEALERSHIP
Was Received In
Regional Office
Completion Date
HEADQUARTERS
DEALER LICENSE
CHECK
CHECK NUMBER
AMOUNT
CASH
CREDIT CARD
PAYMENT NUMBER
NUMBER
ACTIVE
INACTIVE
Continuing
Education
Pre-Licensing
DATE:
_
SURETY BOND/
CONTINUATION CERT.
GARAGE LIABILITY
Insp #__________
Insp Name:
____________
I/We hereby agree that all documents, orders, notices or related correspondence will be served by e-mail at the e-mail address provided.
I/We agree to add dealerservices@flhsmv.gov as a contact so that email from the Division of Motorist Services is not classified as junk
mail. If no e-mail address is provided, all documents shall be served by First Class U.S. Mail.
“Under penalty of perjury, I do swear to affirm that all 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.”
Original Signature of the Officer_______________________________________________________
Print Name_________________________ Title____________________ Date
___________________