REQUEST FOR CHASSIS WHOLESALE FINANCING

Chassis Company (complete Legal Name, City, State, Zip New Vehicle Financing Requested
Code)
No. Units Make Series Price Total Price
$ $
$ $
$ $
Proprietorship LLC Partnership Corporation (State: _______) Total New Vehicle Financing Requested: $
Total Financing Requested: (including current Ford Credit $
Outstandings)
Date Established: _
Franchise Name (if applicable): Number of Demonstrator Units Requested:
Current Annual Sales: $
Current Annual Sales (units):
Selling Dealer's Name and Address:

Ownership and Corporate Identification

Principal Owners Age % Active? (Yes or No) Affix Seal or Attach Articles of
Ownership Incorporation to Assure
Accurate Identification of
Corporation Name
Corporate Seal:

Size and Nature of Operation

Present Actual Projected % of Total
Vehicles in Operation Date: Date: Inventory
Cars Trucks Total Cars Trucks Total
Stock Inventory
Units in Conversion
Finished Inventory

Present Finance Source (Bank, Finance Co., or Other)

Source Name, Phone No., and Acct. Loan Officer Active Approved Line Outstandings Guarantors
No. Since $ Date ( )

Insurance Coverage
Agent Name, Address, and Phone No.:
Collision Deductible: Cars - $ Trucks - $ Comprehensive: ACV $ (deductible)
Public Liability: Single - $ Multiple - $ Property Damage: $

Accountant's Name, Address and Telephone:

By: Title: Date:

Attach the following items to this request:
• Last two year-end audited, reviewed tax returns and accompanying internal direct financial statements.
• Year to date internal direct financial statement.

DOC 324-1 FC Request for Chassis Wholesale Financing 1/12/2015