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Bank Reference
Name of Business:
Legal Name (if different):
Date Established:
Tax ID Number:
Retailer or Wholesaler?: -Retailer  -Wholesaler
Street Address:
City:
State: Zip:
Telephone No.:
FAX No.:
E-Mail Address:

Bank Reference
Name of Bank:
Address:
Contact:
Checking Account Number:
Phone Number:

Dealer Information

-Corporation  -Proprietorship  -Partnership
Year-to-Date Sales:
Current Floor Plan Source:
Floor Plan Contact:
Phone:

Company Owners (List All)
Name/Title:
Street Address:
City, State, ZIP:
% Ownership:
SS#:
Phone:
 
Name/Title:
Street Address:
City, State, ZIP:
% Ownership:
SS#:
Phone:
   
Name/Title:
Street Address:
City, State, ZIP:
% Ownership:
SS#:
Phone:

Use the space below to provide any additional information or explanations
By submitting this Dealer Application, I/We certify that all information herein is true and complete. I/We authorize Diversified Dealer Services, LLC d/b/a Diversified Auto Funding and any business affiliates it may do business with to retain this application, to rely on the foregoing; to make any investigations necessary, and to secure credit reports concerning creditworthiness.

Signature required on all applications faxed or mailed!        Date

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Diversified Dealer Services, LLC d/b/a Diversified Auto Funding
One Exchange Place - Sixth Floor - Waterbury, CT 06702
tel: 203-596-9888 fax: 203-596-0011  e-mail: info@divfinancial.com

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