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APPLICATION FOR DEALERS LICENSE

STATE OF RHODE ISLAND ‐‐ DIVISION OF MOTOR VEHICLES Dealer Section 600 New London Avenue ,Cranston, RI 02920-3024 www.dmv.ri.gov

13. NAME OF INSURANCE COMPANY: ________________________________________________________

14. NAME OF EMPLOYEES INSURED UNDER SAID POLICY FOR DEALER PLATES ASSIGNED TO

PROPOSED DEALER: 1 . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 . _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

4. 5.

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15. NUMBER OF PRIVATELY REGISTERED CARS, TRUCKS, FLAT BEDS, AND TOW - TRUCKS

R E G I S T E R E D P E R S O N A L L Y O R T O T H E B U S I N E S S : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

R E G I S T R A T I O N N U M B E R ( S ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

____________________________________________________________________________________________ 16. BUSINESS REFERENCES AND TELEPHONE NUMBERS:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_____________________________________________________________________________________________ 17. YOU MUST HAVE AN APPROVED LINE OF CREDIT FOR FIFTY THOUSAND DOLLARS ($50,000.00) FROM A FINANCIAL INSTITUTION.

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I, THE UNDERSIGNED, HEREBY DECLARE THAT I AM ________________________________________________

(TITLE, IF ANY) OF THE ABOVE FIRM AND THE ABOVE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE OR BELIEF. WRITTEN SIGNATURE OF APPLICANT:_______________________________________________________________ STATE OF RHODE ISLAND COUNTY OF: _____________________________ SUBSCRIBED AND SWORN TO BEFORE ME THIS ______________DAY OF ________________20____

____________________________________________ NOTARY PUBLIC COMISSION EXPIRES

________________________

DLR013 – DATED 08-25-10

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