Form 440-2963 "Manufactured Structures Dealer Supplemental License Application" - Oregon

What Is Form 440-2963?

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 440-2963 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 440-2963 "Manufactured Structures Dealer Supplemental License Application" - Oregon

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Manufactured Structures
Mail application with payment to:
DCBS Fiscal Services
Dealer Supplemental License Application
P.O. Box 14610
Oregon Department of Consumer and Business Services
Salem, OR 97309-0445
Division of Financial Regulation
DEPARTMENT USE ONLY
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
 Approved  Denied
Date:
503-378-4140  Fax: 503-947-7862
Signature:
http://dfr.oregon.gov
A person must have a valid manufactured structures dealer license to apply for a supplemental license.
Approval of this application allows the applicant to open an additional place of business under the same business name. If the
licensed dealer will operate an additional place of business under a different business name, the dealer must apply for a separate
dealer license for that business.
Please complete all steps before submitting your application and refer to the checklist at the end of this form.
STEP 1: APPLICANT INFORMATION
Licensee’s Name:
License number:
STEP 2: ADDITIONAL PLACE OF BUSINESS INFORMATION
Street address of additional place of business:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
STEP 3: TYPES OF MANUFACTURED STRUCTURES SOLD
At the additional place of business:
Applicant will sell new manufactured structures:
Yes
No
Applicant will sell used manufactured structures:
Yes
No
Applicant will sell new recreational vehicles (RVs):
Yes
No
If applicant will sell new RVs wider than 8.5 feet, enter the street address of the RV service facility:
Facility address:
Phone: (
)
City:
State:
ZIP:
Continued on next page
The fee for a supplemental license is $90. The license expires on the same date the manufactured structures dealer
license expires.
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
Credit card number
Expiration date
Department of Consumer & Business Services.
If paying by credit card, applicant must sign
credit card information box. Do not send cash.
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440-2963 (10/19/COM)
Manufactured Structures
Mail application with payment to:
DCBS Fiscal Services
Dealer Supplemental License Application
P.O. Box 14610
Oregon Department of Consumer and Business Services
Salem, OR 97309-0445
Division of Financial Regulation
DEPARTMENT USE ONLY
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
 Approved  Denied
Date:
503-378-4140  Fax: 503-947-7862
Signature:
http://dfr.oregon.gov
A person must have a valid manufactured structures dealer license to apply for a supplemental license.
Approval of this application allows the applicant to open an additional place of business under the same business name. If the
licensed dealer will operate an additional place of business under a different business name, the dealer must apply for a separate
dealer license for that business.
Please complete all steps before submitting your application and refer to the checklist at the end of this form.
STEP 1: APPLICANT INFORMATION
Licensee’s Name:
License number:
STEP 2: ADDITIONAL PLACE OF BUSINESS INFORMATION
Street address of additional place of business:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
STEP 3: TYPES OF MANUFACTURED STRUCTURES SOLD
At the additional place of business:
Applicant will sell new manufactured structures:
Yes
No
Applicant will sell used manufactured structures:
Yes
No
Applicant will sell new recreational vehicles (RVs):
Yes
No
If applicant will sell new RVs wider than 8.5 feet, enter the street address of the RV service facility:
Facility address:
Phone: (
)
City:
State:
ZIP:
Continued on next page
The fee for a supplemental license is $90. The license expires on the same date the manufactured structures dealer
license expires.
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
Credit card number
Expiration date
Department of Consumer & Business Services.
If paying by credit card, applicant must sign
credit card information box. Do not send cash.
1 of 2
440-2963 (10/19/COM)
Continued from previous page
STEP 4: AFFIDAVIT OF APPLICANT
Read the following statements, check each box, sign, and date.
1. The applicant will act as a manufactured structures dealer and will conduct business at the location stated on this
application.
2. If the street address of the applicant’s business is in a residential zone, all manufactured structures sold or displayed at
that address will meet any architectural and aesthetic standards regulating the placement of manufactured structures in
that residential zone.
3. If the applicant will offer for sale new recreational vehicles greater than 8.5 feet in width, the applicant will maintain an
RV service facility for those RVs at an address provided on this application.
4. The information on this application is complete and correct.
5. I am authorized to sign this application.
Signature and printed name and title of sole proprietor, partner, corporate officer, or LLC member:
Signature:
Date:
Print name:
Title:
STEP 5: APPLICANT CHECKLIST
1. Application form completed
2. Affidavit signed by authorized person
3. Payment of $90.00 fee enclosed
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440-2963 (10/19/COM)
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