GUARANTEED ASSET PROTECTION APPLICATION
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Name of Applicant:  
Address:  
City:   State:   Zip:  
Phone Number:  (        )   Fax Number:  (        )  
E-mail Address:  
Contact Person:   Title:  
Phone Number:  (        )   Fax Number:  (        )  
TYPE OF INSTITUTION:
  
Comercial Bank Finance Company
Savings Bank Other:
Credit Union
PORTFOLIO DESCRIPTION:
(Please complete separate application for each instrument type and for each Origination Source)
 
INSTRUMENT:
  
Loan Balloon Loan
Lease Other:
COLLATERAL:
  
  % Private Passenger Vehicles
  % Recreational Vehicles
  % Commercial Vehicles
  % Other:
  % New Loans
  % Used Loans
  % New Leases/Balloon Loans
  % Used Leases/Balloon Loans
ORIGINATION SOURCE:
  
Direct Dealer
GEOGRAPHIC ORIGINATION (FOUR LARGEST STATES):
  
   %
   %
   %
   %

PORTFOLIO INFORMATION:   YTD   Last YR   2 Yrs 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 		           
PORTFOLIO COMPOSITION:
Please provide data as requested on attached application addendum on the last page of application packet.
 
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:(If sold on Optional Basis)
  
At Applicant's Location(s)
At Dealer
Other:

INSURANCE INFORMATION:
Yes No Collision Insurance Requirements
Do you require that the borrower carry adequate insurance naming you as the loss payee?
Do you require written evidence of this insurance?
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:
Is it reinsured?
  If yes, name of reinsurer:
  
Blanket
Optional To Borrower
EXISTING GAP INSURANCE RESULTS SUMMARY:
    YTD   Last YR   2 Yrs Ago
Premium Paid to Carrier ($)            
Losses Paid By Carrier ($)
(Excluding Loss Adjustment Expense) 		           
 
 
I hereby declare that all statements made in this application are true to the best of my knowledge. I also understand that completion of this application does not constitute the binding of insurance and that Premier Lease & Loan Services reserves the right to request additional information as may be reasonably necessary.
 
 
Signature:   Title:  
 
 
Name:   Date:  
 
Agent Use Only
 
Agent:   Agent Code:  
 
 
Name:   Date:  
 
 
 
Please submit to Southeastern Underwriters, Inc. - P.O. Box 15420 Richmond, Virginia 23227-5420 - Phone: (800)777-1815 Fax:(800)727-3452