Form ITD 3181 Personal History and Application for Idaho Factory Representative - Idaho

Form ITD3181 is a Idaho Department of Transportation form also known as the "Personal History And Application For Idaho Factory Representative". The latest edition of the form was released in February 1, 2010 and is available for digital filing.

Download a PDF version of the Form ITD3181 down below or find it on Idaho Department of Transportation Forms website.

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Personal History And Application
ITD 3181 (Rev. 02-10)
itd.idaho.gov
For Idaho Factory Representative
Idaho Transportation Department
Vehicle Services
PO Box 34; Boise, ID 83731-0034
Enclose a $44.00 application fee with a completed application for each factory representative-
Check appropriate box(es):
Original Application
Renewal
Duplicate (Lost Card - $18)
Owner/Officer (No charge)
Add Manufacturer
Change Manufacturer
Idaho Code 49-1602(1): The Department may refuse to issue a license to an applicant who has ever been convicted in
a court of record in this state of a violation of a law, provision, or rule and regulation promulgated for this act.
(a) Have you previously been licensed as a manufacturer, vehicle/vessel salesperson, factory
Yes
No
representative, dealer, dismantler, or transporter in Idaho or any other state?
(b) Are you now licensed as a manufacturer, vehicle/vessel salesperson, factory representative or dealer
Yes
No
in Idaho or any other state?
If yes to either (a) or (b), list previous card number
State
Date
Previous Manufacturer
Name
No.
Previous Manufacturer
Location
(c) Have you ever had a Vehicle Dealer, Salesperson, or Manufacturer License revoked, suspended, or
subjected to other disciplinary action or were you ever a partner, officer, director, or stockholder in a
Yes
No
firm whose license was revoked in Idaho or any other state?
If yes, please explain the circumstances on the back of this form.
Driver's License Number
Driver's License State
Social Security Number
Date of Birth
Name as it Appears on Your Driver's License (Last, First, Middle) Please Print or Type
Sex
Height
Weight
Eye Color
Hair Color
Daytime Phone Number
Residence Address (Number and Street - No PO Box)
City
State
Zip
THE UNDERSIGNED hereby makes application for a manufacturer’s factory representative license in accordance with the provisions of the
Idaho manufacturer's license act.
I affirm under penalty of license forfeiture that the answers and information contained herein are true and correct to the best of my knowledge
and belief. This form must be completed in full or it will be returned.
Applicant's Signature
Check if Inactive Owner/Officer/Director
Manufacturer Name
Primary Manufacturer Number
Manufacturer Location
Sponsoring Manufacturer Certification for Factory Representatives:
I hereby certify that a background check has found the applicant suitable for a factory representative position, and that he/she is
an employee over 18 years of age. I understand that this application is invalid until submitted to ITD and fees are paid.
Printed Name of Authorized Manufacturer Representative
Signature of Authorized Manufacturer Representative
Date
X
Distribution: Original - ITD
Copy - Applicant
Personal History And Application
ITD 3181 (Rev. 02-10)
itd.idaho.gov
For Idaho Factory Representative
Idaho Transportation Department
Vehicle Services
PO Box 34; Boise, ID 83731-0034
Enclose a $44.00 application fee with a completed application for each factory representative-
Check appropriate box(es):
Original Application
Renewal
Duplicate (Lost Card - $18)
Owner/Officer (No charge)
Add Manufacturer
Change Manufacturer
Idaho Code 49-1602(1): The Department may refuse to issue a license to an applicant who has ever been convicted in
a court of record in this state of a violation of a law, provision, or rule and regulation promulgated for this act.
(a) Have you previously been licensed as a manufacturer, vehicle/vessel salesperson, factory
Yes
No
representative, dealer, dismantler, or transporter in Idaho or any other state?
(b) Are you now licensed as a manufacturer, vehicle/vessel salesperson, factory representative or dealer
Yes
No
in Idaho or any other state?
If yes to either (a) or (b), list previous card number
State
Date
Previous Manufacturer
Name
No.
Previous Manufacturer
Location
(c) Have you ever had a Vehicle Dealer, Salesperson, or Manufacturer License revoked, suspended, or
subjected to other disciplinary action or were you ever a partner, officer, director, or stockholder in a
Yes
No
firm whose license was revoked in Idaho or any other state?
If yes, please explain the circumstances on the back of this form.
Driver's License Number
Driver's License State
Social Security Number
Date of Birth
Name as it Appears on Your Driver's License (Last, First, Middle) Please Print or Type
Sex
Height
Weight
Eye Color
Hair Color
Daytime Phone Number
Residence Address (Number and Street - No PO Box)
City
State
Zip
THE UNDERSIGNED hereby makes application for a manufacturer’s factory representative license in accordance with the provisions of the
Idaho manufacturer's license act.
I affirm under penalty of license forfeiture that the answers and information contained herein are true and correct to the best of my knowledge
and belief. This form must be completed in full or it will be returned.
Applicant's Signature
Check if Inactive Owner/Officer/Director
Manufacturer Name
Primary Manufacturer Number
Manufacturer Location
Sponsoring Manufacturer Certification for Factory Representatives:
I hereby certify that a background check has found the applicant suitable for a factory representative position, and that he/she is
an employee over 18 years of age. I understand that this application is invalid until submitted to ITD and fees are paid.
Printed Name of Authorized Manufacturer Representative
Signature of Authorized Manufacturer Representative
Date
X
Distribution: Original - ITD
Copy - Applicant

Download Form ITD 3181 Personal History and Application for Idaho Factory Representative - Idaho

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