Untitled Document

MECHANIC SHOP INFORMATION

Date (mm-dd-yyyy)*

Mechanic Shop Name*

Phone Number*

Tax ID Number*

Business Address*

Email*

REPRESENTATIVE INFORMATION

First Name*

Last Name*

Phone Number*

VEHICLE INFORMATION

Date vehicle was left for repairs? (mm-dd-yyyy)*

Is the vehicle currently registered in Texas?*

Is this a Salvage Titled vehicle?*

Year

Make

Model

Body Style

Vehicle Identification Number (VIN#)*

License Plate Number

Color*

Mileage*

Please upload a copy of your Photo ID, Repair Order, and Business Card*
Note: Current photo identification (State or U.S. government issued ID only) This can be a drivers license, photo ID or passport. No Foreign Id's will be accepted

CLIENTS CERTIFICATION, AUTHORIZATION AND AGREEMENT

WARNING: FALSIFYING INFORMATION IN THIS APPLICATION IS A FELONY UNDER THE TEXAS PENAL CODE

The undersigned certify the following

I/We fully understand that it is a State crime punishable by fine and or imprisonment to knowingly make any false statements when applying for Auto Title Transactions of any kind, Title Transfers, Title Bonds, Surety Bonds, Auto Registrations, Mechanic Liens, Lost Title Replacements, 30 Day Tags, Dealer Licensing, Insurance, Etc.

I/We have requested and rendered the services of The Texas Auto Title Company. I/We have made no misrepresentations in the application or other documents, nor did I/We omit any pertinent information.

I/We understand and agree that The Texas Auto Title Company reserves the right to review the information provided on the application as well as my or our insurance identification card or policy, odometer reading, and sales price.

I/We fully understand that service fees are and will be non-refundable

The applicant or an authorized agent hereby certifies under penalty of perjury that statements made in this application for a dealer license, attachments and additional documents submitted for the completion of application for a dealer’s license submitted to The Texas Auto Title Company herewith are true, complete, correct, submitted in their entirety, and accurately represented. Applicant agrees to allow The Texas Auto Title Company to examine ownership documents pertaining to the business. Applicant agrees to allow the Texas Department of Transportation to examine during working hours the ownership papers for each registered or unregistered vehicle in the applicant’s possession or control. Applicant swears they are not at this time delinquent in any court-ordered obligation to pay child support or any other judgement’s against them. The applicant has complied with all applicable state laws and municipal ordinances.

NON-REFUNDABLE LICENSE FEES: If you have a felony conviction or are found ineligible for a license or permits, your fees cannot be refunded. It must have been at least three years since the termination of sentence, parole, mandatory supervision or probation for a felony conviction before you may be deemed eligible for in particular a motor vehicle dealer’s license. Criminal history checks will be conducted on each and every applicant.

By initialing and check marking below I certify that I have read all and agreed to all terms and conditions set forth. By typing my name below I certify it to be a valid e signature

Date (mm-dd-yyyy)*

First Name*

Last Name*

Terms and Conditions

I have read and agreed to all Terms and Conditions set forth by this Certification, Authorization and Agreement

I have read and agree to The Texas Auto Title Companies Privacy Policy