Confidential Dealer Application Download a printable application if you prefer to fax instead. Download Please enable JavaScript in your browser to complete this form.Dealership InformationCompany Legal NameDBA (if applicable)How did you hear about us?Street Address *City *State *State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCounty *Zip *Phone *FaxEmail *Time in BusinessYears at Current BusinessBusiness TypeBusiness TypeCorporationPartnershipSole ProprietorshipLLCDealership Business WebsiteAmount RequestedHow did you hear about us?Dealership ServicesMechanicalBHPH If so, what %# Units Per MonthAvg. Purchase PriceAvg. Days to SellDo you wholesale Y/N# Per MonthLot CapacityCurrent InventoryUnits Owned OutrightEstimated Value $Current FloorplansCurrent Floorplans Name 1Current Floorplans Line of Credit 1Current Floorplans Name 2Current Floorplans Line of Credit 2Current Floorplans Name 3Current Floorplans Line of Credit 3Applicant / Guarantor InformationApplicant First NameApplicant Last NameApplicant TitleApplicant SSNApplicant Cell PhoneApplicant Email *Applicant Street AddressApplicant CityApplicant State *State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingApplicant ZipCo-Applicant / Guarantor InformationCo-Applicant First NameCo-Applicant Last NameCo-Applicant TitleCo-Applicant SSNCo-Applicant Cell PhoneCo-Applicant EmailCo-Applicant Street AddressCo-Applicant CityCo-Applicant StateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCo-Applicant ZipReferencesAuction ReferenceAuction Reference Phone NumberAuction Reference 2Auction Reference 2 Phone NumberAuction Access NumberSignature(s)Applicant/Guarantor Signature *Applicant/Guarantor Signature Date *Co-Applicant/Guarantor SignatureCo-Applicant/Guarantor Signature DateApplication Complete *By checking this box, I affirm that all information provided on this application is complete and accurate to the best of my knowledge.By submitting this application and requesting consideration for loan approval, you are authorizing Funding Branch to verify credit information contained in your application.Submit