983 Old Eagle School, Suite 616 Wayne, PA 19087
PHONE: 800-446-5950 FAX: 610-254-9893

GUARANTEED AUTO PROTECTION (GAP)
(Please print this application, fill it out, then mail or fax it using the information above)

Applicant Name:_______________________________________________________________
Address:_____________________________________________________________________
Contact Person:______________________________ Title:______________________________

Phone: (         )                                                       Fax: (          )                                
 
Nature of Business:____________________________ Years in business:________________
Quotation Requested for:              (        ) Leases                            (        ) Loans

                                                  (        ) Basic                              (        ) Broad

                                                  (        ) Blanket basis                   (        ) Voluntary basis

Proposed effective date:______________________________________________
Please indicate vehicle type(s):

(    ) Auto    (    ) Truck    (    ) Tractor Trailer    (    ) Other (describe)___________________

(    ) New    (    ) Used
1. Is the applicant a subsidiary of another entity, or does the applicant have any     subsidiaries? (   ) yes  (   ) no If yes, please explain_______________________

2. Is there any exposure for flammables, explosives or chemicals? (   ) yes   (   ) no

3. Do you currently have GAP coverage?_______   If yes, please provide name of
    insurance company and expiration date._____________________

4. Has any policy or coverage been declined, canceled or non-renewed in the past three     years? (   ) yes (   ) no If yes, please provide details_______________________

    Please attach loss history for past three years.

5. What percentage of your portfolio, during the past 12 months,
    falls into these categories?

____________ Repossessions ____________Early Payoffs ____________ Total Loss

6. What percentage of your portfolio is:

________% A paper ________% B paper ________% C paper ________% D paper
 
Portfolio Information:

                                                                    New Vehicles  Used Vehicles

Anticipated number of leases next 12 months:  _____________ ____________

Anticipated number of loans next 12 months:    _____________ ____________

Number of leases sold: Current Year_______ Last Year_______ Prior Year_______

Number of loans issued: Current Year_______ Last Year_______ Prior Year_______

Lease term: minimum_________mos.  maximum_________mos.  average_________mos.

Loan term: minimum__________mos.  maximum__________mos.  average__________mos.

Lease value: minimum $__________ maximum $__________ average $__________

Loan value: minimum $__________ maximum $__________ average $__________

Percentage of leases: Commercial__________ Private__________

Percentage of loans: Commercial__________ Private__________

What percent of leases are above MSRP?_______ Below MSRP?_______ Average MSRP?_______

Expected GAP sales, as a % of total loans/leases: ________% of loans ________% of leases
Please provide general geographic spread of leases/loans:

___________________________________________________________________________
Please specify the top ten models in the portfolio:

___________________________________________________________________________
Please provide comments, remarks and other pertinent underwriting information:

___________________________________________________________________________

___________________________________ ______________________ _______________
                Applicant Signature                                 Title                             Date