What is the legal name of your business?

       Corporation:

C. Corp.
S. Corp.
LLC

       Partnership:

Limited
General

           Proprietorship:

Physical address of your business

( No P.O. Boxes accepted)

Street Address:

City:

State:

Zip:

Landlord Contact:

Phone:

Do you own this property:

Monthly rent/mortgage:

Business Phone:

Fax number:

Mobile number:

Principal contact:

Corporation President:

Corporation Secretary:

Other contact:

Master Dealer Number:

Federal Tax ID Number:

Bonding Co.

Phone:

Bond #

Years in car business

Time owned this business:

Time at this location:

Approximate amount of own funds in business:

In your BHPH portfolio:

How often do you prepare financial statements:

Monthly
Quarterly
Annually
Only with tax filings

Bank Name:

Account #

Contact:

Phone:

BUSINESS OWNERSHIP INFORMATION

Guarantor name & residential address:

County:

Years at above address:

Home Phone:

Date of birth:

SS#

Percent ownership of the business:

FINANCING/BULK SALE SOURCES

References

Contact Name

Phone

FLOORPLAN/PRIMARY INVENTORY SOURCES

References

Contact Name

Phone

ACKNOWLEDGEMENT AND AUTHORIZATION

The information contained in this statement is provided for the purpose of obtaining or maintaining credit with Dealers Capital, Inc. and/or Automotive Dealers Finance, Inc. on behalf of the undersigned or persons, firms, corporations in whose behalf the undersigned may either severally, or jointly with others, execute a guaranty in the Lenders favor. Each undersigned understands that the Lender is relying on the information provided herein (including the designation made as to ownership of property) in deciding to grant or continue credit. Each undersigned represents and warrants that the information provided is true and complete and that the Lender may consider this statement as true and correct until a written notice of a change is given to the Lender by the undersigned. The Lender is authorized to make all inquiries it deems necessary to verify the accuracy of the statements made herein and to determine the credit worthiness of the undersigned, including criminal information and driving records. Neither Dealers Capital, Inc. nor its agent shall be violating my right to privacy in any manner and I hereby release them from all liability for actions related to this investigation. The Lender is authorized to answer questions about its credit experience with the undersigned.

Current date:

Digital Signature of Authorized Officer:

Digital Signature (Guarantor):