All Fields are required on this form

Dealer ID (ex XXXX-00)

Dealer Name

Fund Req Date

Year

Make

Model

Color

Mileage

VIN#

Date Purchased

Clean Retail Value

Clean Trade Value

Funds Requested

Photo of Car

Photo of VIN

Photo of Bill of Sale

Photo of NADA Values

Photo of Title *Dealer must possess physical title OR provide form(s) noted below.

*Lien payoffs must be completed by Partners Capital Finance (authorization for payoff AND vehicle power of attorney forms required).

Authorization for Payoff - Lender Form

Vehicle Power Of Attorney Form

*Dealer to dealer purchases must be completed by Partners Capital Finance (authorization for payment form required).

Authorization for Payment - Dealer Form