Confidential Dealer Application

Download a printable application if you prefer to fax instead.

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Dealership Information

Company Legal Name

DBA (if applicable)

How did you hear about us?

Street Address *

City *

State *

County *

Zip *

Phone *

Fax

Email *

Time in Business

Years at Current Business

Business Type

Dealership Business Website

Amount Requested

How did you hear about us?

Dealership Services

Mechanical

BHPH If so, what %

# Units Per Month

Avg. Purchase Price

Avg. Days to Sell

Do you wholesale Y/N

# Per Month

Lot Capacity

Current Inventory

Units Owned Outright

Estimated Value $

Current Floorplans

Current Floorplans Name 1

Current Floorplans Line of Credit 1

Current Floorplans Name 2

Current Floorplans Line of Credit 2

Current Floorplans Name 3

Current Floorplans Line of Credit 3

Applicant / Guarantor Information

Applicant First Name

Applicant Last Name

Applicant Title

Applicant SSN

Applicant Cell Phone

Applicant Email *

Applicant Street Address

Applicant City

Applicant State *

Applicant Zip

Co-Applicant / Guarantor Information

Co-Applicant First Name

Co-Applicant Last Name

Co-Applicant Title

Co-Applicant SSN

Co-Applicant Cell Phone

Co-Applicant Email

Co-Applicant Street Address

Co-Applicant City

Co-Applicant State

Co-Applicant Zip

References

Auction Reference

Auction Reference Phone Number

Auction Reference 2

Auction Reference 2 Phone Number

Auction Access Number

Signature(s)

Applicant/Guarantor Signature *

Applicant/Guarantor Signature Date *

Co-Applicant/Guarantor Signature

Co-Applicant/Guarantor Signature Date

Application 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.