Form 440-2964 "Manufactured Structures Dealer and Limited Manufactured Structures Dealer License Correction Application" - Oregon

What Is Form 440-2964?

This is a legal form that was released by the Oregon Department of Consumer and Business Services - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Oregon Department of Consumer and Business Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 440-2964 by clicking the link below or browse more documents and templates provided by the Oregon Department of Consumer and Business Services.

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Download Form 440-2964 "Manufactured Structures Dealer and Limited Manufactured Structures Dealer License Correction Application" - Oregon

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Mail application with payment to:
Manufactured Structures Dealer and
DCBS Fiscal Services
Limited Manufactured Structures Dealer
P.O. Box 14610
License Correction Application
Salem, OR 97309-0445
Oregon Department of Consumer and Business Services
Division of Financial Regulation
DEPARTMENT USE ONLY
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
 Approved  Denied
Date:
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
Signature:
http://dfr.oregon.gov
A licensed manufactured structures dealer may use this form to:
Change the street address, mailing address, if the dealer has moved the principal place of business, the additional place
of business (supplemental license), or the recreational vehicle service facility.
Change the assumed business name or DBA.
A licensed limited manufactured structures dealer may use this form to:
Change the mailing address of the business.
Change the assumed business name or DBA.
A dealer may not use this form to change the name of the sole proprietorship, partnership, corporation, or LLC that holds the
license. A change of ownership requires a new application.
Please complete all steps before submitting your application.
STEP 1: APPLICANT INFORMATION
Licensee’s Name:
License number:
STEP 2: CORRECTIONS TO PRIMARY PLACE OF BUSINESS
Enter any corrections needed to the information for the primary place of business or check here if not applicable
New DBA or ABN:
New street address:
City:
State:
ZIP:
New mailing address:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
STEP 3: CORRECTIONS TO THE RECREATIONAL VEHICLE SERVICE FACILITY
Enter any corrections needed to the information for the recreational vehicle service facility or check here if not applicable
New street address:
Phone: (
)
City:
State:
ZIP:
Continued on next page
The fee to correct a license is $30.
Secure fax payment: 503-947-2333
Visa
MasterCard
Discover
Phone:
Fiscal use only: 12104/0600 92700/93040/1007
Cardholder signature
Amount
Name of cardholder as shown on credit card
Make check or money order payable to
$
Department of Consumer & Business Services.
Credit card number
Expiration date
If paying by credit card, applicant must sign
credit card information box. Do not send cash.
1 of 2
440-2964 (10/19/COM)
Mail application with payment to:
Manufactured Structures Dealer and
DCBS Fiscal Services
Limited Manufactured Structures Dealer
P.O. Box 14610
License Correction Application
Salem, OR 97309-0445
Oregon Department of Consumer and Business Services
Division of Financial Regulation
DEPARTMENT USE ONLY
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
 Approved  Denied
Date:
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
Signature:
http://dfr.oregon.gov
A licensed manufactured structures dealer may use this form to:
Change the street address, mailing address, if the dealer has moved the principal place of business, the additional place
of business (supplemental license), or the recreational vehicle service facility.
Change the assumed business name or DBA.
A licensed limited manufactured structures dealer may use this form to:
Change the mailing address of the business.
Change the assumed business name or DBA.
A dealer may not use this form to change the name of the sole proprietorship, partnership, corporation, or LLC that holds the
license. A change of ownership requires a new application.
Please complete all steps before submitting your application.
STEP 1: APPLICANT INFORMATION
Licensee’s Name:
License number:
STEP 2: CORRECTIONS TO PRIMARY PLACE OF BUSINESS
Enter any corrections needed to the information for the primary place of business or check here if not applicable
New DBA or ABN:
New street address:
City:
State:
ZIP:
New mailing address:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
STEP 3: CORRECTIONS TO THE RECREATIONAL VEHICLE SERVICE FACILITY
Enter any corrections needed to the information for the recreational vehicle service facility or check here if not applicable
New street address:
Phone: (
)
City:
State:
ZIP:
Continued on next page
The fee to correct a license is $30.
Secure fax payment: 503-947-2333
Visa
MasterCard
Discover
Phone:
Fiscal use only: 12104/0600 92700/93040/1007
Cardholder signature
Amount
Name of cardholder as shown on credit card
Make check or money order payable to
$
Department of Consumer & Business Services.
Credit card number
Expiration date
If paying by credit card, applicant must sign
credit card information box. Do not send cash.
1 of 2
440-2964 (10/19/COM)
Continued from previous page
STEP 4: CORRECTIONS TO SUPPLEMENTAL PLACE OF BUSINESS
Enter any corrections needed for the supplemental place of business or check here if not applicable
New street address:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
STEP 5: AUTHORIZED SIGNATURE
I am authorized to submit these corrections. The information on this application is complete and correct. I authorize the
Division of Financial Regulation to make corrections to the dealer license.
Signature:
Date:
Print name:
Title:
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440-2964 (10/19/COM)
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