Dealer Application

Dealer Name*

DBA*

Tax ID*

Street address*

City*

State/Region*

Postal Code*

Phone*

Fax Number

Email*

Website URL*

State Of Incorporation*

Date of Incorporation*

Legal Structure*

Have you or any other principal(s) of the dealer had ownership in another dealership?*

If yes, please list the name of the dealership, address and date(s) of ownership

Has the dealer had any adverse findings regarding business practices by any regulatory agency within the past 5 years?*

If yes, please explain

Are there any current or pending claims, lawsuits, or judgements against the dealer or dealership?*

If yes, please explain

Has the dealer ever been suspended or terminated from doing business with any lending institution?*

If yes, please explain

Dealership Locations

(If more than one)

Dealership Name

Street Address

City, State, Postal Code

Phone

Fax

Website

Dealer Contact Person

Cell Phone

Attached Copy of Dealer License

Dealership Name

Street Address

City, State, Postal Code

Phone

Fax

Website

Dealer Contact Person

Cell Phone

Attached Copy of Dealer License

Dealership Name

Street Address

City, State, Postal Code

Phone

Fax

Website

Attached Copy of Dealer License

NOTE: If you have additional branch offices, please submit the additional locations via email to calston@mobilitytrust.com following the same format listed above.

Business References

Please List Banking Relationship, Financial Company, Floor Plan, ETC.

Reference 1*

Name, Address, Phone, & Contact Required

Reference 2*

Name, Address, Phone, & Contact Required

Reference 3

Name, Address, Phone, & Contact Required

Reference 4

Name, Address, Phone, & Contact Required

Funding Information

Account Information For Funding Loan Contracts

Name of Bank*

Name on Account*

Routing Number*

Account Number*

For Principals

Principal Name*

% Of Ownership*

Residence Address*

Title*

Contact Number*

Date of Birth*

Name

% Of Ownership

Residence Address

Title

Contact Number

Date of Birth

Name

% Of Ownership

Residence Address

Title

Contact Number

Date of Birth

It is understood that Mobility will make reference inquiries and may order credit reports and/or independent background checks on the dealer, dealership and/or principals. By submitting this completed packet, the dealer authorizes the release of financial and other information as may be required to evaluate the dealer and/or dealership.

Principal 1

Print full name

Date

of signature

Principal 2

Print full name

Date

of signature

Principal 3

Print full name

Date

of signature