FLORIDA DEPARTMENT OF AGRICULTURE AND
CONSUMER SERVICES
ADAM H. PUTNAM
COMMISSIONER
MOTOR VEHICLE REPAIR
REGISTRATION APPLICATION
Sections 559.901 – 559.9221, Florida Statutes
Rule 5J-12.002, Florida Administrative Code
FLORIDA DEPARTMENT OF AGRICULTURE AND
CONSUMER SERVICES
ADAM H. PUTNAM
COMMISSIONER
MOTOR VEHICLE REPAIR
REGISTRATION APPLICATION
Sections 559.901 – 559.9221, Florida Statutes
Rule 5J-12.002, Florida Administrative Code
Florida Department of Agriculture and Consumer Services
Motor Vehicle Repair Registration Application
Table of Contents
Table of Contents
Page I
Initial Application Checklist
Page II
Pages 1 – 4
Registration Application
FDACS-10900 Rev. 10/16
Page I of II
APPLICATION CHECKLIST AND STIONS
A
MILITARY FEE WAIVER FOR INITIAL REGISTRATION
The department shall waive the initial registration fee for an honorably discharged veteran of the United States Armed Forces,
the spouse of such a veteran, or a business entity that has a majority ownership held by such a veteran or spouse if the
department receives FDACS-10900, Motor Vehicle Repair Registration Application, Rev. 10/16, FDACS-10991, Military
Veteran Fee Waiver Request, 10/16, and required documentation within 60 months after the date of the veteran’s discharge
from any branch of the United States Armed Forces. FDACS-10991, Military Veteran Fee Waiver Request, 10/16, is
incorporated by reference in rule 5J-26.001, F.A.C. Please see s. 559.904(3)(b), F.S., for waiver qualifications.
PPLICATION CHECKLST AND NCNS
APPLICATION CHECKLIST
Please make sure that the following documents are submitted with the registration application:
1.
Please submit correct registration fee. (see pages 3 and 4)
2.
Attach a copy of your estimate and invoice form(s) to the registration application. A sample estimate
and
invoice
form
is
available
at
http://www.freshfromflorida.com/Divisions-Offices/Consumer-
Services/Business-Services/Motor-Vehicle-Repair-FAQ.
3.
If you have additional locations, you must submit a separate application for each location.
Once your completed application has been approved, the department will issue you a two (2) year registration to
operate as a motor vehicle repair shop. You will be notified by the department when it is time to renew your
registration.
FDACS-10900 Rev. 10/16
Page II of II
Florida Department of Agriculture and Consumer Services
Division of Consumer Services
Make check or money order payable
MOTOR VEHICLE REPAIR
and remit application to:
REGISTRATION APPLICATION
FDACS
P.O. Box 6700
Tallahassee, FL 32314-6700
Section 559.904, Florida Statutes
Rule 5J-12.002, Florida Administrative Code
ADAM H. PUTNAM
COMMISSIONER
1-800-HELP-FLA (435-7352) • 850-410-3800 Calling Outside Florida
www.800helpfla.com • 850-410-3804 Fax
All documents and attachments submitted with this statement are subject to public review pursuant to Chapter 119, F.S.
Please allow thirty (30) days for the processing of your application. Failure to submit all of the required information will
delay processing of your application. All fees are non-refundable.
Business Information
Please Select one:
MV
DTN __________________
New Filing
Change of Owner
Renewal
(If you have recently purchased an existing motor vehicle
(as issued by the department and listed on the preprinted renewal
repair shop, please check both boxes)
application)
1. Name of Motor Vehicle Repair Shop
:
(as registered with the Florida Department of State, Division of Corporations)
2. DBA or Fictitious Name
:
(as registered with the Florida Department of State, Division of Corporations)
3. Business Street Address
:
(include APT or SUITE # in all address lines)
City:
State:
Zip Code:
-
Mailing Address
:
(if different from above)
City:
State:
Zip Code:
-
Business Telephone Number:
Fax Number:
(
)
-
(
)
-
Email Address*:
Website:
*
Future correspondence may be electronic, so please ensure the provided email address is accurate and valid.
4. Federal Employer ID Number
(FEIN):
Motor Vehicle Repair
-
Org Code: 42 10 06 25 000
EO: A2
Object Code: 001161
$100/$300/$600
FDACS-10900 Rev. 10/16
Page 1 of 4
5. Ownership / Form of Organization, PLEASE CHECK ONE and provide the legal name as registered with the
Florida Department of State.
Sole Proprietorship
:
(Provide Name of Owner)
Corporation
Limited Liability Partnership
Limited Liability Company
Partnership
Other
:
(please describe)
Name of Corporation
:
(as registered with the Florida Department of State, Divisions of Corporations)
Physical Street Address
:
(include APT or SUITE # in all address lines)
City:
State:
Zip Code:
-
Mailing Address
:
(if different from above)
City:
State:
Zip Code:
-
6. Enter the name and address of the individual owner, or all general partners, or all corporate officers and directors.
(attach additional copies as needed using the same format)
[s. 559.904(10), F.S.]
Name:
Title:
Address:
City:
State:
Zip Code:
-
Telephone Number:
(
)
-
Name:
Title:
Address:
City:
State:
Zip Code:
-
Telephone Number:
(
)
-
FDACS-10900 Rev. 10/16
Page 2 of 4
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