Form 901 - Application For Permit To Operate As A Motor Vehicle/marinecraft Leasing Company

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LEASE/RENTAL NUMBER

EXPIRATION YEAR

MISSOURI DEPARTMENT OF REVENUE

FORM

MOTOR VEHICLE BUREAU

901

APPLICATION FOR PERMIT TO OPERATE AS A

MOTOR VEHICLE/MARINECRAFT LEASING COMPANY

(SEE INSTRUCTIONS ON REVERSE SIDE)

(REV. 11-07)

SECTION A: DO NOT WRITE IN THE SHADED AREAS OF THIS FORM

1. TELEPHONE NUMBER (INCLUDE AREA CODE)

CAUTION: Due to the form margins, please adjust the page

scaling setting to "Fit to Printable Area" before printing.

2. PERSON TO CONTACT

Failure to do so may result in an incomplete form.

MAIL TO:

STREET

CITY

COUNTY

STATE

ZIP CODE

IMPORTANT: If you are a corporation, partnership, or individual doing business under another name (DBA), record your legal name in Section 3 and your DBA in Section 3a.

3. BUSINESS NAME

3A. DBA NAME

STREET

COUNTY

4. MISSOURI RETAIL SALES TAX LICENSE NUMBER

CITY

STATE

ZIP CODE

5. REGISTRATION NUMBER ON FILE WITH THE

MISSOURI SECRETARY OF STATE’S OFFICE

6. MOTOR VEHICLE DEALER NUMBER

7. BOAT DEALER NUMBER

8. SALVAGE BUSINESS NUMBER

EXP. YEAR

9. TYPE OF

10. TYPE OF UNITS

11. SALES TAX OPTION SELECTED

OPERATION:

LEASED/RENTED:

ELECTS NOT TO PAY THE TAX DUE AT THE TIME OF REGISTRATION OF ALL OF ITS MOTOR VEHICLES, TRAILERS,

A. LEASE

A. MOTOR VEHICLES

D. TRAILERS

WATERCRAFT OR OUTBOARD MOTORS BUT WILL COLLECT AND REMIT ALL APPLICABLE TAXES ON THE AMOUNT CHARGED

B. RENTAL

B. BOATS

E. OTHER

FOR EACH RENTAL OR LEASE AGREEMENT WHILE THE UNIT IS DOMICILED IN THIS STATE.

C. LEASE & RENTAL

C. OUTBOARD MOTORS

1. INDIVIDUAL

2. PARTNERSHIP

3. CORPORATION (STATE OF INCORPORATION):

12. TYPE OF OWNERSHIP

LIST ANY BRANCH LOCATIONS IF APPLICABLE: (USE SEPARATE SHEET IF NECESSARY)

13. NAME

ADDRESS

CITY

STATE

ZIP CODE

TELEPHONE NO.

OWNER(S)

14. LIST ALL OWNERS BELOW: (IF A CORPORATION, LIST ALL PRINCIPAL OFFICERS. ATTACH SEPARATE SHEET FOR ADDITIONAL OWNERS)

LAST NAME

FIRST

HOME ADDRESS

CITY

STATE

ZIP CODE

HOME TELEPHONE NO.

15. I HEREBY CERTIFY THAT THE COMPANY NAMED HEREIN IS ENGAGED IN THE BUSINESS OF RENTING OR LEASING MOTOR VEHICLES, TRAILERS, BOATS AND/OR OUTBOARD MOTORS,

WHICH ARE TO BE USED EXCLUSIVELY FOR RENTAL OR LEASING PURPOSES, AND NOT FOR RESALE. I FURTHER RESOLVE, AS THE AUTHORIZED OFFICER OF SAID COMPANY, THAT I HAVE

ELECTED TO EXERCISE THE SALES TAX OPTION STATED IN BLOCK # 11 ABOVE AS PROVIDED IN SECTION 144.070, RSMo., WITH RESPECT TO ALL UNITS HELD FOR RENTING OR

LEASING PURPOSES. I FURTHER CERTIFY THAT ALL THE INFORMATION RECORDED HEREIN IS TRUE AND ACCURATE.

SIGNATURE OF OWNER OR OFFICER LISTED ABOVE

TITLE

DATE

SECTION B: COMPLETE THIS SECTION IF THE BUSINESS NAMED IN SECTION A IS A DIVISION OF A CORPORATION

16. NAME OF PARENT CORPORATION

ADDRESS

CITY

STATE

ZIP CODE

TELEPHONE NO.

17. LIST ALL OTHER DIVISIONS AND THEIR ADDRESSES (USE SEPARATE SHEET OF PAPER IF NECESSARY)

NAME OF DIVISION

ADDRESS

CITY

STATE

ZIP CODE

TELEPHONE NO.

18. I HEREBY CERTIFY THAT I AM A CORPORATE OFFICER OF (CORPORATE NAME) ________________________________________________________________________________________

AND THAT THE APPLICANT NAMED IN SECTION A IS A DIVISION OF SAID CORPORATION. I AUTHORIZE THE APPLICANT NAMED IN SECTION A TO APPLY TO THE DIRECTOR OF

REVENUE FOR A PERMIT TO OPERATE AS A LEASE/RENTAL COMPANY IN THE STATE OF MISSOURI. APPLICANT AGREES TO COMPLY WITH ITEMS 1 THROUGH 3 ON THE BACK OF

THIS APPLICATION.

SIGNATURE OF OFFICER OF PARENT CORPORATION

DATE

FOR OFFICE USE ONLY

DATE APPROVED

DATE REJECTED

APPROVED BY

MO 860-0311 (11-07)