ncm bhph 20 group application

Name:

Title:

Business Name:

Address:

City:

State:

Zip Code:

Phone:

Fax:

E-Mail:

Check all that apply:

Single Point Location

Multi-Point Location

Related Finance Company

Location 1
# of units sold per month	# of outstanding accounts
$ value of outstanding accounts	Type of computer software
How long at this location	Age of facility

Location 2
# of units sold per month	# of outstanding accounts
$ value of outstanding accounts	Type of computer software
How long at this location	Age of facility

Location 3
# of units sold per month	# of outstanding accounts
$ value of outstanding accounts	Type of computer software
How long at this location	Age of facility

% Of Business You Own

Give names, relationship, and % of ownership of other owners:

Spouse's Name (If Applicable)

Involved In Dealership?

Yes

Children Ages

Involved In Dealership?

Yes

If you own other businesses or dealerships, indicate location, franchises, and % of ownership:

Location

Franchises

% Of Ownership

If you would like to give professional or personal achievement information, please use this space:

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