Dealer Plates for Heavy Trucks for Demonstration Purposes

This form contains an information treating the issue on Dealer Plates for Heavy Trucks for demonstration purposes.

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State of Florida
Department of Highway Safety and Motor Vehicles
Dealer Plates for Heavy Trucks for Demonstration Purposes

Dealership Information:
Name of Dealership: ________________________________________________________________
Address: _________________________________________________________________________
City:__________________________ State: __________________ Zip Code: _________________
Dealer License Number: _____________________________________________________________

Driver Information:
Name of Driver:____________________________________________________________________
Address:__________________________________________________________________________
City:__________________________ State:__________________ Zip Code: _________________
Telephone number: _________________________________________________________________
Driver License Number: _____________________________________________________________
Dealer License Plate Number:_________________________________________________________
Vehicle Identification Number:________________________________________________________
Date &Time Demonstration Started:____________________________________________________
Date &Time Demonstration Ended:_____________________________________________________ _
Total Number of Hours:______________________________________________________________ (Not to exceed 24 consecutive hours)
Signature of Driver:_________________________________________________________________
Name of Dealer Representative: _______________________________________________________
Signature of Dealer Representative: ____________________________________________________
To Be Retained at the Dealership for Audit by the Department
“Under penalty of perjury, I do swear or affirm that all the information contained in this application
is true and correct.”
Signature of Dealer Principal/Officer Typed Name and Title
HSMV 82084 (Rev 1/13)