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APPLICATION FOR SALES REPRESENTATIVE LICENSE

(VS-426; Rev. June 21) FEES: $ per applicant APPLICATION FOR SALES REPRESENTATIVE LICENSE . NCDMV VEHICLE SERVICES - DEALER UNIT. 3129 MAIL SERVICE CENTER, RALEIGH, NC 27697-3129. 1. APPLICANT INFORMATION. Please print legibly. Use complete legal name as it appears on your Driver's LICENSE /ID Card. Applicant Name: _____ Driver's LICENSE Number: _____. Physical Address: _____. City:_____ State:_____ Zip:_____. Birthdate: _____ Race: _____ Weight: _____. Hair Color: _____ Sex:_____ Height:_____ Eye Color:_____. Dealer Salesman_____ Distributor SALES Rep_____ Factory Rep_____. 2. ENDORSEMENT BY EMPLOYER. AS EMPLOYER I UNDERSTAND THAT I AM RESPONSIBLE FOR THE ACTS OF ALL SALES . REPRESENTATIVES EMPLOYED BY ME WHILE ACTING AS MY AGENT.

(g) The completion of, or active participation in, rehabilitative drug or alcohol treatment. (VS-426; Rev. June 21) FEES: $21.50 per applicant Requirements continued.

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