PA Pre-Owned Inventory Loan Request Form

Polaris Acceptance

Dealer Name:

*

PA Office/Control # :

5400

PA Dealer # :

*

PA Account Manager

*

Submitted by:

*
Date: 3/10/2010 Email address: *
* = required field
Unit #
Product Type
(please group
by type)
YR (2 digit) /
Model
Make / Serial # (last 8 digits)
Dealer Purchase
Price / Trade in
Allowance
NADA Value/
Kelley Wholesale
Clean Value
PA Advance
Amount
1
$
$
$
2
$
$
$
3
$
$
$
4
$
$
$
5
$
$
$
6
$
$
$
7
$
$
$
8
$
$
$
9
$
$
$
10
$
$
$
    Total Amount of Loan / Invoice:
$
 
Application of Loan Proceeds (please which one applies):
ACH transfer to dealer's account
Apply to PA account balance as indicated below
Other- See special instruction below
 
PA Pre-Owned Inventory Loan Request Form
Dealer to Complete This Section For Funds Application
PA Dealer #
Invoice #
Serial #
(last 8 digits)
Amount of
Principal or
Curtailment
  
Billing Charge Type
Billing Date
Amount
to Apply
to Billing
$   $
$   $
$   $
$   $
$   $
$   $
$   $
Total Principal:   $ Total Charges:   $
Total applied to account:   $  
Total funded to Dealer:   $
 
 
 
I agree to the terms below.     Yes       No
The Dealer identified herein (“Dealer”) hereby requests Polaris Acceptance (“PA”) to make a loan to Dealer under the loan agreement between Dealer and PA ("Loan Agreement") with respect to the inventory (“Collateral”) identified above. Dealer represents and warrants to PA that (1) Dealer owns the Collateral free and clear of all liens and encumbrances, (2) the information contained herein is true and correct, and (3) Dealer will pay PA therefore under the terms and conditions of the Loan Agreement, as may be amended from time to time. Dealer grants PA a security interest in the Collateral and the proceeds thereof. Eligibility of the Collateral for a loan and the amount of the loan, if any, made with respect to the Collateral will be determined by PA in accordance with the financing program terms in effect from time to time. The amount of the loan and the terms of repayment will be provided to Dealer on a Transaction Statement or Statement of Transaction. “ Units Financed are subject to bill of sale audit upon request”

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