Lease'T'Own Program Application | Northland Auto Solutions

Lease’T’Own® Program Enrollment

Business Name*
DBA*
Business Address*
Street Address City State ZIP Code
Mailing Address*
Street Address City State ZIP Code
Phone*
Fax
Dealer License #*
Business Type
FEIN
Contact Person Phone #*
Claims Contact Person*
*E-mail*
Company Website
Principal(s) and Manager(s)*
Title*
Years in Auto Business*
Principal(s) and Manager(s)
Title
Years in Auto Business
Principal(s) and Manager(s)
Title
Years in Auto Business
Name of Current Dealer Management System (DMS)*
Will you use the Northland Lease agreement?
- Yes
- No
If no, lease agreement must be attached for pre-approval
Drop files here or
Max. file size: 256 MB.
Name of Current Garage Policy Carrier*
Garage Policy Number*
DEALER AGREEMENT*
By checking this box, I acknowledge I have read and understand my responsibilities as outlined on the pages of the Dealer Agreement.
Choose method of payment for recurring monthly insurance premiums*
- Credit Card
- ACH from Bank Account
*
I authorize Northland to withdraw payments from the designated checking account or credit card that has been selected for my recurring monthly insurance premiums.*
ENROLLMENT FEE*
I understand the one-time enrollment fee is $979.00. After submission of your enrollment, it will be emailed to Northland. Once reviewed, you will receive a call to confirm receipt and collect payment.
AGREEMENT*
By checking this, I acknowledge and hereby authorize that pursuant to Northland Auto Enterprise, Inc (DBA: Northland Auto Solutions) programs or purchases, I have elected to have my payments and other amounts that might be due per my agreement or purchases be made via electronic debits from my bank account or credit card. I further acknowledge that payment in this manner will lessen the chance of delinquent payments and thus establish a good credit referral, as well as accurately track payments. I further understand that I can cancel this authorization at any time.
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REQUIRED! CLICK HERE FOR DEALER AGREEMENT

To become a Lease’T’Own dealer, there is a one-time enrollment fee of $979.00. The enrollment fee provides you with the following:

Program eligibility for all your dealership locations.
Dealer & Administrative Staff Training
Contracts & Forms (including replenishment at No Charge)
Dealer Guidebook & Updates
Use of our Trademarked Program Name & Logo
Customer Insurance Tracking (Gold Program)
Outstanding & Ongoing Dealer Support

ADDITIONAL COSTS

Monthly insurance premiums – premium amounts vary based on fleet size and chosen coverage level.
GPS Tracking Devices (optional)
Coverage Plus (optional)