Dealer Information and Application - Mariner Finance

[Pages:1]Dealer Information and Application

Date: ____ / ____ / ____

DEALER INFORMATION Dealer Name: _____________________________________ Aba Name: _______________________________________

Phone: (____)__________________ Fax: (____)__________________

Address: _______________________________________________________________________________________________

City: _______________________________ State: ________

Length of time at present address: ___________________

E-mail Address: ____________________________________

Website URL: __________________________________

Mortgage Holder/Landlord: ____________________________

Phone: (____)__________________

Address: _________________________________________________________

City: _______________________________ State: ________

Length of time at present address:___________________

Previous Address:________________________________________________________________________

City: _______________________________ State: ________

Length of time at previous address:__________________

BUSINESS INFORMATION

Type of Business: ___________________________________ Date Established ___ / ___ / ___ In business for _______ years.

Ownership: circle one.

Sole Owner

Partnership

Corporation

Sub Chapter

If sole owner or partnership, is trade registered? Please circle, Yes or No

Principals:

Name: _____________________________ Title:_________________________ S.S. _____-_____-______

Home Address: _____________________________________________________ Please sign here* ______________________

Name: _____________________________ Title:_________________________ S.S. _____-_____-______

Home Address: _____________________________________________________ Please sign here* ______________________

Name: _____________________________ Title:_________________________ S.S. _____-_____-______

Home Address: _____________________________________________________ Please sign here* ______________________

TRADE REFERENCES

Name: __________________________________________

Phone Number: (____)__________________

Home Address: _____________________________________________________

Name: __________________________________________

Phone Number: (____)__________________

Home Address: _____________________________________________________

Name: __________________________________________

Phone Number: (____)__________________

Home Address: _____________________________________________________

BANK OF DEPOSIT

Name: __________________________________________________________ Account Number: ________________________

Address:_________________________________________________________ Phone Number: (____)____________________

City: _______________________________ State: ___ Zip: ________

Account holder for ________ years.

SALES INFORMATION Annual Financed Income: ____________________________________ Average size transaction: $_________________________ Paper to be submitted will represent the sale of __________________________________________________________________ Sales Area___________________Number of locations _____ Description of guaranty/warranty _____________________________________________________________________________ Financial statements of __________________________ : Yes____ No ____

(If no, give reason) ________________________________________________________________________________

Firm _____________________________________________________ Name________________________________________

*By signing above, I hereby authorize Finance Maryland to perform investigative consumer reports (including credit reports)

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