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

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.