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GAP Application GAP Application Name of Applicant Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip  - Phone -- Fax -- E-mail Address Contact Contact Phone -- Contact Fax -- Title Type of Institution Comercial Bank Finance Company Savings Bank Other:   Credit Union Instrument Loan Balloon Loan Lease Other:   Portfolio Information Please round all values to the nearest dollar % Private Passenger Vehicles % Recreational Vehicles % Commercial Vehicles % Other   Name: % New Loans % Used Loans % New Leases/Balloon Loans % Used Leases/Balloon Loans Origination Source Direct Dealer Geographic Origination (Four Largest States) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming % Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming % Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming % Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming % Portfolio Information   Y.T.D. Last Year 2 Years Ago Number of Instruments Made Number of Instruments Outstanding Maximum Instrument Amount Average Instrument Amount Average Sales Price as % of MSRP/NADA Retail Average Down Payment as % of Sales Price Min Down Payment as % of Sales Price Average Original Term (months) Average Actual Term (months) Maximum Original Term Average APR Number of Total Losses Reported To You Number of Thefts Reported To You Average Deficiency if Insurance Settlement is Insufficient to pay off the Instrument Residual Value Publication Used:(If Lease or Balloon Loan) ALG Avg. % of Published Residual Used Black Book Max % of Published Residual Used Other:   Type of Coverage Requested Blanket Non-Reinsured Blanket Reinsured Voluntary Non-Reinsured Voluntary Reinsured Other If reinsured, do you own a reinsurance company that you wish to use? Point of Sale At Applicant's Locations At Dealer Other    Insurance Information Yes   No Do you require that the borrower carry adequate insurance naming you as the loss payee? Yes   No Do you require written evidence of this insurance? Yes   No Is insurance monitoring now provided by a service company?   If yes, name of service company?   Your Current GAP Insurance Yes   No Do you currently have GAP insurance on your portfolio?   If yes, name of carrier?   Yes   No Is it reinsured?   If yes, name of reinsurer?   Blanket Optional To Borrower Existing GAP Insurance Results Summary   Y.T.D. Last Year 2 Years Ago Premium Paid to Carrier($) Losses Paid By Carrier($) (Excluding Loss Adjustment Expenses) Agent Information Agent Name Agent Code