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Dealership Form
Dealership Form
Name of Registrant
(Required)
Address
(Required)
Street Address
Address Line 2
City
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State
ZIP Code
Effective Date
(Required)
MM slash DD slash YYYY
Licensed Plate
(Required)
New Licensed Plate
Existing Licensed Plate
If it's an existing License Plate what vehicle is it coming from? (Make & Year)
Is this a New Vehicle Or Used Vehicle?
(Required)
New Vehicle
Used Vehicle
Vehicle Information
Year
Make
Model
S, LX, L?
VIN
Lease, Finance or Cash?
Lease
Finance
Cash
Bank Information (If Lease or Finance)
Bank Name
Bank Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Cost Of Vehicle After Tax?
Number of Airbags?
Number of Airbags?
ABS Brakes
Yes
No
Daytime Running Lights?
Yes
No
Does Vehicle have an Alarm?
Yes
No
If yes, is it Active or Passive?
Active
Passive
If new & unused vehicle, please fax us the bill of sale or lease agreement & window sticker.
Name
This field is for validation purposes and should be left unchanged.
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