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Vehicle Year Make & Model (VIN if available):
Purchase Price:
Mileage: Check One: NEW or USED
Business legal Name
Business D/B/A Name
Type of Business Entity: (Check One)
Corporation
Sole Proprietor
Partnership
Limited Partnership
Limited Liability Partnership
Limited Liability Company
State of incorporation
Fed Tax ID
Physical Street Address
City
Street
Zip
Billing Street Address (if different than above):
City
Street
Zip
Physical Location Phone
Billing Location Phone
Preferred Contact Phone
Industry Type (SIC Code or Description)
Rented
Mortgaged
Business Start Date
Owner's First and Last Name
Ownership %
Title
Email
Mobile
Date of Birth
SSN
Home Address
City
State
Zip
Dealership Name
Location (city/state)
Dealership Website
Owner/Officer #1 Name
Owner/Officer Signature
Date
Owner/Officer #2 Name
Owner/Officer Signature
Date
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