Form 440-2962 "Manufactured Structures Dealer License Application" - Oregon

What Is Form 440-2962?

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 440-2962 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 440-2962 "Manufactured Structures Dealer License Application" - Oregon

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Manufactured Structures
Mail application with payment to:
DCBS Fiscal Services
Dealer 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
 Approved  Denied
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
Date:
503-378-4140  Fax: 503-947-7862
Signature:
http://dfr.oregon.gov
Please complete all steps before submitting your application and refer to the checklist at the end of this form.
STEP 1: APPLICANT INFORMATION
Legal name of applicant (sole proprietorship, partnership, corporation, or LLC):
Business name of applicant (DBA/ABN):
Federal Tax Identification Number:
Type of entity:
Sole proprietorship
Partnership
Corporation of the state of
LLC
Business street address:
City:
State:
ZIP:
Business mailing address (if different):
City:
State:
ZIP:
Phone: (
)
Fax: (
)
STEP 2: CONTACT PERSON
Provide the name and address of a contact person.
Name:
Title:
Address:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
STEP 3: REAL ESTATE BROKER INFORMATION
If the applicant is a licensed real estate broker, complete this section.
Name on broker license:
Type of broker:
Broker
Principal broker
License no.:
Expiration date:
Continued on next page
The fee for a manufactured structures dealer license is $542. The license is valid for three years from the date of issue.
Visa
MasterCard
Discover
Phone:
Secure fax payment: 503-947-2333
Cardholder signature
Amount
Fiscal use only: 12104/0600 92700/93040/1007
Name of cardholder as shown on credit card
$
Credit card number
Expiration date
Make check or money order payable to
Department of Consumer & Business Services.
If paying by credit card, applicant must sign
440-2962 (10/19/COM)
credit card information box. Do not send cash.
1 of 3
Manufactured Structures
Mail application with payment to:
DCBS Fiscal Services
Dealer 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
 Approved  Denied
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
Date:
503-378-4140  Fax: 503-947-7862
Signature:
http://dfr.oregon.gov
Please complete all steps before submitting your application and refer to the checklist at the end of this form.
STEP 1: APPLICANT INFORMATION
Legal name of applicant (sole proprietorship, partnership, corporation, or LLC):
Business name of applicant (DBA/ABN):
Federal Tax Identification Number:
Type of entity:
Sole proprietorship
Partnership
Corporation of the state of
LLC
Business street address:
City:
State:
ZIP:
Business mailing address (if different):
City:
State:
ZIP:
Phone: (
)
Fax: (
)
STEP 2: CONTACT PERSON
Provide the name and address of a contact person.
Name:
Title:
Address:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
STEP 3: REAL ESTATE BROKER INFORMATION
If the applicant is a licensed real estate broker, complete this section.
Name on broker license:
Type of broker:
Broker
Principal broker
License no.:
Expiration date:
Continued on next page
The fee for a manufactured structures dealer license is $542. The license is valid for three years from the date of issue.
Visa
MasterCard
Discover
Phone:
Secure fax payment: 503-947-2333
Cardholder signature
Amount
Fiscal use only: 12104/0600 92700/93040/1007
Name of cardholder as shown on credit card
$
Credit card number
Expiration date
Make check or money order payable to
Department of Consumer & Business Services.
If paying by credit card, applicant must sign
440-2962 (10/19/COM)
credit card information box. Do not send cash.
1 of 3
Continued from previous page
STEP 4: TYPES OF MANUFACTURED STRUCTURES SOLD
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, provide the street address of the RV service facility:
Facility address:
Phone: (
)
City:
State:
ZIP:
STEP 5: OWNER, PARTNER AND OFFICER INFORMATION
Print the names of owners, partners, or corporate officers. A Social Security number is required for each person. If there are
more than five owners or corporate officers, copy this page as needed and attach to the application.
Additional pages attached and submitted as part of this application:
Yes
No
Name:
Title:
Residence address:
City:
State:
ZIP:
Mailing address (if different):
City:
State:
ZIP:
Phone: (
)
Email:
Percentage of ownership:
Date of birth:
Social Security number (required):
Name:
Title:
Residence address:
City:
State:
ZIP:
Mailing address (if different):
City:
State:
ZIP:
Phone: (
)
Email:
Percentage of ownership:
Date of birth:
Social Security number (required):
Name:
Title:
Residence address:
City:
State:
ZIP:
Mailing address (if different):
City:
State:
ZIP:
Phone: (
)
Email:
Percentage of ownership:
Date of birth:
Social Security number (required):
Name:
Title:
Residence address:
City:
State:
ZIP:
Mailing address (if different):
City:
State:
ZIP:
Phone: (
)
Email:
Percentage of ownership:
Date of birth:
Social Security number (required):
Continued on next page
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440-2962 (10/19/COM)
Continued from previous page
STEP 6: SUPPLEMENTAL LICENSES
An applicant for a manufactured structures dealer license must apply for a manufactured structures dealer supplemental
license if the applicant is going to open an additional place of business under the same business name. The applicant must
submit a Manufactured Structures Dealer Supplemental License Application (Form 440-2963) for each additional place of
business.
Applicant is submitting a supplemental license application:
Yes
No
STEP 7: BOND OR LETTER OF CREDIT REQUIREMENT
A bond, in the amount of $40,000 for each year the license is valid, or a letter of credit must be submitted before the Division of
Financial Regulation issues a license. The bond must be submitted on a Division of Financial Regulation surety bond form
(440-2966). Give the form to your insurance agent. When the agent returns the form, sign it and submit the original and power
of attorney with your application.
STEP 8: OTHER LICENSES
If applicant is or has been licensed as a manufactured structures dealer in another state, provide the following information:
State:
License number:
Applicant has been suspended, revoked, or placed on probation:
Yes
No
STEP 9: AFFIDAVIT OF APPLICANT
Read the following statements, check each box that is true, 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 a
recreational-vehicle service facility for those recreational vehicles at a street 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 10: APPLICANT CHECKLIST
1. Application form completed with Affidavit (Step 9) signed by authorized person
2. Supplemental pages listing additional owners enclosed, if applicable
3. Supplemental license applications enclosed, if applicable
4. Surety bond or letter of credit enclosed
5. Applicant signed surety bond
6. Payment of $542.00 fee enclosed
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440-2962 (10/19/COM)
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