Brasher's Idaho Auto Auction, Inc Attention: Loan Servicing Boise, ID 83171 PHONE: (208) 345-7345 FAX: (208) 395-3148 28 Day to Pay Agreement Loan Application Date of Application: ________________ Business/Dealership Name: ___________________________________________________________ Street Address: _____________________________________________________________________ City/State/Zip: _____________________________________________________________________ Mailling Address: ___________________________________________________________________ City/State/Zip: _____________________________________________________________________ Business Phone: ___________________ Mobil Phone: ________________ Fax: ________________ Type of Dealer: New Car: ______ Used Car: _______ Wholesale: ________ Date Dealersip Established: _____________________________ Dealer License #: _____________________________________ Federal Tax #: ________________________________________ State Resale Tax#: ____________________________________ Average number of vehicels purhased monthly at all auctions: _____________________________ Average purchase price per vehicle: _________________ Dealership is a: Proprietorship _______ Partnership ________ Corporation _________ Brasher's Idaho Auto Auction, Inc Attention: Loan Servicing Boise, ID 83171 PHONE: (208) 345-7345 FAX: (208) 395-3148 28 Day to Pay Agreement List of Owners/Partners Dealership is a: Proprietorship _______ Partnership ________ Corporation _________ Name: ______________________________ Residence Phone: ___________________________ Address: ___________________________________ Social Security Number: ____ - ____ - ____ City: ___________________________________ Date of Birth: ___________________ State: _______________ Zip: ____________ Signature: ________________________________ Name: ______________________________ Residence Phone: ___________________________ Address: ___________________________________ Social Security Number: ____ - ____ - ____ City: ___________________________________ Date of Birth: ___________________ State: _______________ Zip: ____________ Signature: ________________________________ Name: ______________________________ Residence Phone: ___________________________ Address: ___________________________________ Social Security Number: ____ - ____ - ____ City: ___________________________________ Date of Birth: ___________________ State: _______________ Zip: ____________ Signature: ________________________________ Credit Release Right to Request Specific Reasons: If your application for business credit is denied, you have the right to a written statement of the specific reasons for denial. To obtain the statement, please contact us at the following address within 60 days of the date you are notified of denial. Brasher's Idaho Auto Auction, Inc. Attention: Loan Servicing P.O. Box 170342 Boise, ID 83171 Reporting Information to credit bureaus: We may report information about your account to credit bureaus. Late payments, missed payments or other defaults on your account may be reflected in your credit report. Applicant's Statement: By signing below, I certify that the information provided on and within this form, including financial statements, is complete and correct and that I am authorized to execute this form on behalf of the Applicant. I authorize Brasher's Idaho Auto Auction, Inc. (Lender) to obtain balance and payoff information on all accounts requiring pay off as a condition of approving this application. I understand that Lender may check my credit records and statements made by me. I give permission to all my creditors to give Lender any information it needs to make credit granting decisions. I further authorize Lender to provide credit reporting agencies and other creditors information relating to any credit Lender might grant to Applicant. I agree to promptly notify Lender of any material changes that would affect the accuracy of the statements. All information is, as of this date, correct unless otherwise stated. I authorize Lender to cause such UCC Financing statements to be filed in such form and in jurisdiction and encumbering such assets as Lender or its counsel deem appropriate in their sole and absolute discretion. Authorization to obtain Credit Report: By signing below, I authorize Brasher's Idaho Auto Auction, Inc. (Lender) to obtain a copy of my credit report in connection with this application for credit, and any modifications, renewals, or extensions of such credit. I acknowledge that Lender shall use the credit report in connection with a credit transaction involving myself, whether or not I am the obligor, guarantor, or principal officer of the applicant, and that Lender has a legitimate business need for the information. I acknowledge that this authorization is continuing in nature, and that Lender may obtain updated or additional credit reports at any time in connection with renewal, extension or other modification of any loan or other credit accommodation between Lender and myself, whether or not I am the obligor, guarantor, or principal officer of the Applicant. I further direct the credit reporting agency to which Lender delivers a copy of this authorization to furnish a credit report to Lender. By signing below, I declare that I have read and understand the statements above. ____________________________ (signature) ______________________________ (printed name) __________________ (date) ____________________________ (signature) ______________________________ (printed name) __________________ (date) ____________________________ (signature) ______________________________ (printed name) __________________ (date) AA Subscribing Customer: Address: City: St/Prov: Postal Code: Phone: Fax: Bank Reference Letter AuctionACCESS® Dealership ID: ______________________ Dealership Name: ________________________________ Owner/Officer Name: Bank Name: _____________________________________ Account #: Bank Address: ___________________________________ ABA#: Bank City: _________________________________ State/Province: ______ Country: _______ Postal Code: Bank Reference Phone: Bank Reference Fax: Attention Credit Department or Officer: The aforementioned Dealership has listed your bank as its principal banking reference. AutoTec, LLC has compiled and maintains a national database, AuctionACCESS®, which contains information on licensed new and used car dealers for use by its automobile industry customers. Since the automobile auctions frequently guarantee dealer checks for cars bought at their auctions, they require that all dealers who do business with the auctions establish their financial responsibility. We would be grateful if you would check mark below your estimate of this account. This information will be incorporated into the AuctionACCESS® database; otherwise, this information will be kept strictly confidential and will be used only for our purposes and the purposes of our Subscribing Customers. Please return this completed letter directly to the above address. Dealership has been banking with your bank since: _______________________ Checking Savings Type(s) of accounts held: The Customer is: Floor Plan ZBA Sweep Regular Account Special Account Loan Account Account is: Controlled Disbursement Satisfactory Unsatisfactory Closed Open Date: Closed Date: A valued customer with a good reputation and financial responsibility Honest and reliable, but limited capital resources Unknown to us A new customer – our experience is limited Negative response Average Balances for six months are: Nominal Small Moderate Negative Balance Medium Large 3 figures 4 figures 5 figures 6 figures 7 figures Insufficient Checks or Drafts: How Many? Does not issue Overdrafts: How Many? Does not issue Maximum Credit recently extended: $____________________________Secured Do you floor plan this Customer? Yes No Floor Plan Line New/Used: $________________ Do you accept their Drafts? Yes No $____________________________Unsecured Floor Plan Outstanding New/Used: $________________ Are all Drafts picked up within 48 hours? Yes No Physical Address of bank for sight Draft: __________________________________________________________________________ Remarks: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Signature of Bank Official: ____________________________________ Title: _______________________________________ Print Name: ________________________________________________ Date: ________________ Phone: ________________ Thank you for your assistance. BRL Form (Rev 04/07/2010) Copyright © 2003-2010 AutoTec, LLC. All rights reserved.
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