DateBank Letter Sent

Dealership Name

Street Address

CityStateZip

Mailing Address

CityStateZip

Telephone#Fax#

State Dealer#Expiration Date

How Long In BusinessHow Long At This Address

State Sales Tax or Resale#Federal Tax ID #

Sole OwnershipCorporationPartnership

Type of  Dealerhip

NewUsedWholesale

Owner #1Home Address

Home Phone # Driver's License#State

Date of BirthSocial Security #

Owner #2Home Address

Home Phone #Driver's License#State

Date of BirthSocial Security #

BANK INFORMATION

Bank #1Acct#

Street AddressCityStateZip

Telephone#Floor Plan Amount

Floor Plan Ind. NameAccount Officer

Account Officer Phone#

Bank #2Street Address

Telephone#Floor Plan Amount

Floor Plan Ind. NameAccount Officer

Account Officer Phone #

AUTHORIZED AGENTS

Print Name #1

SS#Home Phone#

DR. LIC.#DOB

Print Name #2

SS#Home Phone#

DR. LIC.#DOB

Print Name #3

SS#Home Phone#

DR. LIC.#DOB

PLEASE HELP SERVICE YOUR ACCOUNT BETTER....(optional)

We buy approximately0-5050-100100-250over 250 vehicles a year.

We sell approximately0-5050-100100-250over 250 vehicles a year.

Please send me information about your fleet lease institutional sales.