Application for Out-of-State Distributor License
Idaho Transportation Department

ITD 3188 (Rev. 1/24)
dmv.idaho.gov

Mail completed application to: Idaho Transportation Department
PO Box 34
Boise ID 83707-0034
Out-of-State Distributor Information
Dealership EIN

Company Name

DBA (If different from Company Name)

Location Address

CityState

Zip

Mailing Address (if different from above)

City

State

Zip

Owner/Officer’s Printed Name

Contact Person's Printed Name

Area Code/Phone Number (Include extension)

Area Code/Fax Number

Dealer License #Email Address

Product Information – If more space needed, submit additional list
Distributed Product Name(s)Type of Vehicle(s)Check List of Documents to Submit

 The completed application form ITD 3188
 The fee of $190.00 for a new license The fee of $44.00/each for representative licenses
 A copy of the distributor/business license from the state where the business is located For distributors: letter of authorization from each manufacturer allowing to distribute the product in Idaho, if applicable An original, complete Manufacturer’s Statement or Certificate of Origin (MSO / MCO) for each distributed product (maybe voided or marked as “sample”)

 A list of each of the franchised or authorized dealers in the state of Idaho

Fees Submitted*All credit card transactions are subject to a 3% Access Idaho service fee.

New Distributor License - $190.00 ................................................................ $Distributor Representative License(s)(no. of licenses)

Distributor Authorized Representative's Printed Name

@ $44.00 each =$Total Enclosed $Distributor Authorized Representative's Signature

XDate

ITD 3181 (Rev. 5/24)
DMV.Idaho.Gov

Personal History and Applicationfor Idaho Factory Representative
Idaho Transportation Department
Dealer Operations
PO Box 34; Boise, ID 83707-0034

 Enclose a $44.00 application fee with a completed application for each factory representative *Check appropriate box(es):RenewalOriginal Application

Duplicate (Lost Card - $18)

Owner/Officer (no charge)
Idaho Code 49-1602(1): The Department may refuse to issue a license to an applicant who has ever been convicted ina court of record in this state of a violation of a law, provision, or rule and regulation promulgated for this act.
(a) Have you ever had a Vehicle Dealer, Salesperson, or Manufacturer License revoked, suspended, or
subjected to other disciplinary actions or were you ever a partner, officer, director, or stockholder ina firm whose license was revoked in Idaho or any other state.

Yes

NoIf yes, please explain the circumstances on the back of this form.

Driver's License Number

Driver's License State

Social Security Number

Name as it Appears on Your Driver's License (Last, First, Middle) Please Print or Type
Residence Address (Number and Street - No PO Box)

Date of BirthDaytime Phone Number

CityStateZip

THE UNDERSIGNED hereby applies for a manufacturer’s factory representative license in accordance with the provisions of theIdaho manufacturer's license act.
I affirm under penalty of license forfeiture that the answers and information contained herein are true and correct to the best of my knowledge
and belief. This form must be completed in full or it will be returned.
Applicant's Signature
Manufacturer Name

Primary Manufacturer License Number

Manufacturer Location

Sponsoring Manufacturer Certification for Factory Representatives:
I hereby certify that a background check has found the applicant suitable for a factory representative position, and that he/she isan employee over 18 years of age. I understand that this application is invalid until submitted to ITD and fees are paid.
Printed Name of Authorized Manufacturer Representative

Signature of Authorized Manufacturer RepresentativeX* All credit card transactions are subject to a service fee.

Date