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Kansas Department of Revenue

Business Information
  
  
  
  

(two digit state code)

  
   

(Must not contain - or (), exp. 5555555555)

 

(Must not contain - or (), exp. 5555555555)

  
   







Associate Information
  
  

(Must be 6 to 8 characters)

   
   

(exp. mm/dd/yyyy - 01/31/2000)

  
  

(Must not contain - or (), ex. 5555555555)

   

(Must not contain - or (), ex. 5555555555)

Security Questions (You must choose three different questions and provide an answer for each).
   
   
   
   
   
   

(Must not contain - or (), ex. 5555555555)

Check one below: Dealer, Dealer/Lien Holder or Lien Holder Only.
*Choose this selection ONLY, if you are a Dealership who DOESN'T lend.
*Choose this selection ONLY, if you are a Lien Holder but NOT a bank or Credit Union.
*Choose this selection ONLY, if you are a Bank or Credit Union.
Electronic Funds Information
   
   
   
   
   

(Must not contain - or (), exp. 5555555555)