GAP Application

GAP Application

Lender Name   Name of Applicant is required.

Address   Address is required.

City   City is required.

State --Select-- Alaska Alabama Arkansas Arizona 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   State is required.

Zip Code: - A Zip is Required Please enter a valid zip code. Please enter a valid zip code for the last 4 digits (plus 4).

Phone -- A Phone # is Required Please enter a valid Phone # for the area code. Please enter a valid Phone #. Please enter a valid Phone # for the last 4 digits.

Fax -- Please enter a valid Fax # for the area code. Please enter a valid Fax #. Please enter a valid Fax # for the last 4 digits.

Email Address   Email Address is required. Please enter in a valid email address.

Contact   Contact is required.

Contact Phone -- Please enter a valid Contact Phone # for the area code. Please enter a valid Contact Phone #. Please enter a valid Contact Phone # for the last 4 digits.

Contact Fax -- Please enter a valid Contact Fax # for the area code. Please enter a valid Contact Fax #. Please enter a valid Contact Fax # for the last 4 digits.

Title  

Type of Institution - Check all that apply

  Commercial Bank

  Finance Company

  Savings Bank

  Credit Union

Other Institution  

Instrument - Check all that apply

  Loan

  Balloon Loan

  Lease

Other Instrument  

Portfolio Information

% Private Pass. Vehicles   % Private Pass. Vehicles requires a whole number greater than or equal to 0 and less than or equal to 100

% Recreational Vehicles   % Recreational Vehicles requires a whole number greater than or equal to 0 and less than or equal to 100

% Commercial Vehicles   % Commercial Vehicles requires a whole number greater than or equal to 0 and less than or equal to 100

% Other   % Other Vehicles requires a whole number greater than or equal to 0 and less than or equal to 100

Other Name  

% New Loans   % New Loans requires a whole number greater than or equal to 0 and less than or equal to 100

% Used Loans   % Used Loans requires a whole number greater than or equal to 0 and less than or equal to 100

% New Leases/Balloon Loans   % New Leases/Balloon Loans requires a whole number greater than or equal to 0 and less than or equal to 100

   

% Used Leases/Balloon Loans   % Used Leases/Balloon Loans requires a whole number greater than or equal to 0 and less than or equal to 100

   

Origination Source

  Direct

  Dealer

--Select-- Alaska Alabama Arkansas Arizona 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  %  Please enter the $ for your first state. Please enter in a whole number greater than or equal to 0 and less than or equal to 100

--Select-- Alaska Alabama Arkansas Arizona 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  %  Please enter the $ for your second state. Please enter in a whole number greater than or equal to 0 and less than or equal to 100

--Select-- Alaska Alabama Arkansas Arizona 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  %  Please enter the $ for your third state. Please enter in a whole number greater than or equal to 0 and less than or equal to 100

--Select-- Alaska Alabama Arkansas Arizona 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  %  Please enter the $ for your fourth state. Please enter in a whole number greater than or equal to 0 and less than or equal to 100

Portfolio Information

		YTD	Last Year	2 Years Ago
	# Instruments Made	# of Instruments Made YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	# of Instruments Made Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	# of Instruments Made 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	# Instruments Outstanding	# Instruments Outstanding YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Premium Paid to Carrier($) Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Premium Paid to Carrier($) 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Max Instrument Amt.	Max Instrument Amt. YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Max Instrument Amt. Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Max Instrument Amt. Prior Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Avg. Instrument Amt.	Avg. Instrument Amt. YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Instrument Amt. Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Instrument Amt. 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Avg. Sales Price as % of MSRP/NADA Retail	Avg. Sales Price as % of MSRP/NADA Retail YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Sales Price as % of MSRP/NADA Retail Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Sales Price as % of MSRP/NADA Retail 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Avg. Down Payment as % of Sales Price	Avg. Down Payment as % of Sales Price YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Down Payment as % of Sales Price Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Down Payment as % of Sales Price 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Min Down Payment as % of Sales Price	Min Down Payment as % of Sales Price YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Min Down Payment as % of Sales Price Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Min Down Payment as % of Sales Price 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Avg. Original Term (months)	Avg. Original Term (months) YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Original Term (months) Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Original Term (months) 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Avg. Actual Term (months)	Avg. Actual Term (months) YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Actual Term (months) Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Actual Term (months) 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Maximum Original Term	Maximum Original Term YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Maximum Original Term Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Maximum Original Term 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Avg. APR	Avg. APR YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. APR Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. APR 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	# of Total Losses Reported To You	# of Total Losses Reported To You YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	# of Total Losses Reported To You Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	# of Total Losses Reported To You 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	# of Thefts Reported To You	# of Thefts Reported To You YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	# of Thefts Reported To You Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	# of Thefts Reported To You 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Avg. Deficiency if Insurance Settlement is Insufficient to pay off the Instrument	Avg. Deficiency if Insurance Settlement is Insufficient to pay off the Instrument YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Deficiency if Insurance Settlement is Insufficient to pay off the Instrument Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Avg. Deficiency if Insurance Settlement is Insufficient to pay off the Instrument 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000

Residual Value Publication Used - (If Lease or Balloon Loan)

  ALG

Avg. % of Published Residual Used   Avg. % of Published Residual Used requires a whole number greater than or equal to 0 and less than or equal to 100

   

  Black Book

Max % of Published Residual Used   Max % of Published Residual Used requires a whole number greater than or equal to 0 and less than or equal to 100

   

Other Institution  

Type of Coverage Requested

  Blanket Non-Reinsured

  Blanket Reinsured

  Voluntary Non-Reinsured

  Voluntary Reinsured

  Other

Other Name  

If reinsured, do you own a reinsurance company that you wish to use?  

Point of Sale

  At Applicant's Locations

  At Dealer

  Other

Other Name  

Insurance Information

No Yes Do you require that the borrower/member carry adequate insurance naming you as the loss payee?

No Yes Do you require written evidence of this insurance?

No Yes Is insurance monitoring now provided by a service company?

If yes, name of service company?   Please enter the name of your service company.

   

No Yes Do you currently have GAP insurance on your portfolio?

If yes, name of carrier?   Please enter the name of the carrier.

No Yes Is it reinsured?

If yes, name of reinsurer?   Please enter the name of the reinsurer.

   

  Blanket

  Optional To Borrower/Member

Existing GAP Insurance Results Summary

		YTD	Last Year	2 Years Ago
	Premium Paid to Carrier	Premium Paid to Carrier YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Premium Paid to Carrier Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Premium Paid to Carrier 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000
	Losses Paid By Carrier Excluding Loss Adjustment Expenses	Losses Paid By Carrier YTD requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Losses Paid By Carrier Last Year requires a whole number greater than or equal to 0 and less than or equal to 1,000,000	Losses Paid By Carrier 2 Years Ago requires a whole number greater than or equal to 0 and less than or equal to 1,000,000

Agent Information

Agent Name

Agent code