Vantage Finance Dealer Information Form ESIGN

Vantage Finance Dealer Information Form
Date:*

MonthDayYear
Date
Dealership Legal Name*
Dealership Legal Name*
Payment name*
DBA (If Applicable)
Address*
ADDRESS
City*
State (If your state isn't listed, Vantage Finance is not licensed to help you)*
Zip*
Dealership Federal Tax ID*
Multiple Locations? Y or N?*
Date Entity Organized*

MonthDayYear
Date

Dealership Phone*
Time in Business at Current Location
Main Contact Name*
Main Contact Phone*
Fax
Dealer Email (Where Approvals will be sent)*
example@example.com
Dealership Ownership & Organization Information *All owners must be listed, if additional space is needed, please include separate attachment
Dealer License Number*
License Expiration Date*

MonthDayYear
Date
Service Contract License # (FL Dealers Only)
FL License Expiration Date

MonthDayYear
Date
Business Entity Type i.e. LLC, S-Corp, Sole Proprietor, etc
Entity Organization (Domicile)
Owner 1 Name*
Ownership %*
Owner 1 Social Security Number*
Date of Birth*

MonthDayYear
Date
Residential Address, City, State, Zip*
Cell Phone*
Personal Email Address (must be different than Dealership email)*
example@example.com
Owner 2 Name
Ownership %
Owner 2 Social Security Number
Date of Birth

MonthDayYear
Date
Residential Address, City, State, Zip
Cell Phone
Personal Email Address (must be different than Dealership email)
example@example.com
Owner 3 Name
Ownership %
Owner 3 Social Security Number
Date of Birth

MonthDayYear
Date
Residential Address, City, State, Zip
Cell Phone
Personal Email Address (must be different than Dealership email)
example@example.com