Retailer Sign Up Information

 blue dots indicate required fields
Product Type:

check applicable box(es) 
Auto
Recreational
Powersport
Marine
Horse Trailer
Motorcycle
Legal Business Name:  
Operating Name:  
Street Address:  
City:  
State:  
Zip Code:  
Phone Number:  
Fax Number:  
Email Address:  
Dealer Principal's Name (Owner, President):  
Sign up information completed by:
(Must have Legal Signing Authority)
(Owner, President, GM, Sec Treasurer)
 
NAME
 
TITLE
 
Curomax application Lenders we have a VALID Dealer Agreement with:
(Must have a current VALID Dealer Agreement with the Lender)

check applicable box(es) 
Bank of America
KeyBank
Bank of the West
MB Financial
Medallion
Merrick

Other Lenders we have a VALID Dealer Agreement with:
(Must have a current VALID Dealer Agreement with the Lender)

check applicable box(es) 
USBank
Citizens Bank
M&T Bank
Commerce Bank
First Merit Bank
Safeway
Sun Trust Bank
Fifth Third Bank
BB&T Bank
Bank North
HSBC
Harley Davidson Finance
Wachovia

I do not have a valid Agreement with any of these Lenders
Other Lender(s):
Current F & I Software Provider:  
If other, please enter:  
 
Do you use a Service Company: Yes   No
Service Company Information (If Yes)
Service Company Name:  
Legal Business Name:  
Street Address:  
City:  
State:  
Zip Code (If Yes):  
 
Are you a franchised dealer? Yes   No  
Manufacturers/Lines Represented:   


If Other:
Do you belong to a Dealer Group of Companies:

(check applicable box) 
Yes   No
Name of Group (if Yes):  
Average Volume per Month (Units):  
System Access:
(Please provide the proper spelling of names for individuals who will use our application)
 
NAME
 
TITLE

NAME

TITLE

NAME

TITLE
Credit Bureau Access:
(Please choose one or more bureau providers that you would like to have activated on our application)

(check appropriate box)
 First Advantage CREDCO
 Equifax
 Experian
 TransUnion
 I do not wish to enroll with a Credit Bureau Provider
What is the best time to provide  training? (Day & Time):

Click here to print the DEALER PORTAL ACCESS AGREEMENT
Yes, I agree with the Above Terms and Conditions and have the authority to legally bind the Dealer.
No, I do NOT Agree with the Above Terms and Conditions