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Dealer Services - Online Application

Welcome to the Dealers Finance Online Application.  Required fields are marked with a "*".

If you have any questions or are unable to complete this form for any reason, please contact one of our representatives at 1-800-205-6221.

BORROWER INFORMATION

How did you hear about us?



BHPH Line Request: $
Floor Plan Line Request: $
Legal Name of Your Business:*
Type of Organization:




Principal Contact:*
Physical Address of Your Business (P.O. Boxes are not accepted)
Street Address:
City:
State:
Zip:
Business Phone:*
(123-456-7890 or 1234567890 x1234)
Business Fax:
(123-456-7890 or 1234567890 x1234)
Contact E-mail:*
Do you own this property?
Monthly Rent/Mortgage: $
Landlord/Mortgage Company:
Landlord/Mortgage Phone:
(123-456-7890 or 1234567890 x1234)

GUARANTOR INFORMATION

GUARANTOR
Guarantor Name:
Residential Address:
City:
State:
Zip:
County:
Years at Above Address: years
Home Phone:
(123-456-7890 or 1234567890 x1234)
Date of Birth:
Social Security Number:
(XXX-XX-XXXX)
Percent Ownership of Business: %
Add another Guarantor

CORPORATE INFORMATION

Corporate President:
Corporate Secretary:
Other Contact:
Master Dealer Number:
Sales Tax Certificate Number:
Federal Tax ID Number:
Bonding Company:
Bonding Company Phone:
(123-456-7890 or 1234567890 x1234)
Bond Number:
Years in Auto Sales Business:
Years Owned this Business:
Years at this Location:
Approximate Personal Funds Invested: $
Personal Funds in BHPH Portfolio: $
Financial Report are Prepared:


BUSINESS OWNERSHIP INFORMATION

BANKING INFORMATION
Bank Name:
Account Number:
Bank Contact:
Bank Phone:
(123-456-7890 or 1234567890 x1234)
FINANCING/BULK SALE SOURCES
Reference Company:
Contact Name:
Contact Phone:
(123-456-7890 or 1234567890 x1234)
FLOORPLAN/PRIMARY INVENTORY SOURCES
Reference Company:
Contact Name:
Contact Phone:
(123-456-7890 or 1234567890 x1234)

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.

Today's Date: 12/14/2018
Digital Signature of Authorized Officer:
Digital Signature of Guarantor: