Vehicle and Asset Tracking Solutions

Installation Request

Borrower Name & Address

Address

Address Line 2

City

State

Zip code

Phone

Borrowers e-mail

VEHICLE INFORMATION

VIN number

Vehicle Year/Make/Model

INSTALLATION INFORMATION

Installation Location? * Required

Member's Home

Member's Work

Dealership

Shop

CU Branch

Other

Dealer name

Contact name

Phone

Installation Address

City

State

Zip code

CREDIT UNION INFORMATION

Credit union name

Date

Requested by:

Phone

Email

LOAN INFORMATION

Type * Required

Indirect Loan

Direct Loan

Reinstatement

First due date

Number of payments

Payment Amount:

Payment schedule

Monthly

Bi-Weekly

Weekly

Semi-Monthly

If Semi-Monthly please provide

First day payment is due

Second day payment is due

ALL FIELDS MUST BE COMPLETE IN ORDER TO PROCEED WITH INSTALLATION

Thanks for submitting!

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