Legal Auto Application Form

LEGAL AUTO APPLICATION FORM

This Legal Auto Application Form (the Agreement) is entered into by and between Applicant Name: (Applicant) and Provider Name: (Provider) on the Effective Date: .

RECITALS

WHEREAS, Applicant seeks to register, title, finance, obtain services for, or otherwise effectuate transfer or recordation of the motor vehicle described as VIN: , Year: , Make: , Model: (Vehicle);

WHEREAS, Provider is authorized to process title, registration, lien recording and related administrative services and may act as agent for Applicant for the limited purposes set forth in this Agreement; and

WHEREAS, Applicant desires to provide the information and authorizations necessary for Provider to complete registration, title transfer, lien recording, financing application, or related filings on Applicant’s behalf.

NOW, THEREFORE

In consideration of the mutual promises set forth herein, the parties agree as follows:

1. APPLICANT IDENTIFICATION AND CONTACT

Individual    Corporation    Limited Liability Company (LLC)

2. VEHICLE INFORMATION

Existing Lien on Vehicle: Yes    No

3. AUTHORIZATION AND SCOPE

Applicant authorizes Provider to act as Applicant’s agent solely for the purposes of preparing, completing, submitting and delivering applications, forms, transfers, title and registration documents, financing statements, lien recordings, and related administrative filings (the Services). Provider is not authorized to create, amend or discharge any security interest except as Applicant specifically instructs in writing.

Applicant grants Provider a limited power of attorney to execute signatures on forms and documents necessary to effectuate the Services as permitted by applicable law and as reasonably necessary to accomplish the purposes set forth herein.

4. REPRESENTATIONS, WARRANTIES AND CERTIFICATIONS

Applicant represents and warrants that all information provided in this Application is true, complete and correct to the best of Applicant’s knowledge and belief. Applicant acknowledges that knowingly providing false information may result in civil or criminal penalties and may invalidate registration or title applications.

5. CONSUMER REPORTS, MOTOR VEHICLE RECORDS, AND BACKGROUND CHECKS

Applicant expressly authorizes Provider and its agents to obtain consumer credit reports, motor vehicle records, lien and title history reports, and other consumer or commercial reports as reasonably necessary to provide the Services or evaluate financing. Applicant understands that such reports may be retained by Provider as part of Provider’s records.

Applicant acknowledges that Provider may share information contained in this Application with third parties for the limited purposes of completing registration, title, and lien filings, and for financing evaluation. Provider shall use commercially reasonable measures to protect Applicant’s personal information consistent with Provider’s privacy obligations.

6. FEES, PAYMENT AND TAXES

Applicant is responsible for all taxes, title fees, registration fees and governmental charges associated with the Services unless otherwise explicitly stated in writing. Provider may invoice Applicant for fees incurred and Applicant agrees to pay such invoices in accordance with Provider’s billing terms.

7. INDEMNITY AND LIMITATION OF LIABILITY

Applicant agrees to indemnify, defend and hold harmless Provider and its officers, employees and agents from and against any loss, liability, cost or expense (including reasonable attorneys’ fees) arising out of Applicant’s breach of this Agreement, misrepresentations made in the Application, or Applicant’s failure to comply with laws applicable to vehicle ownership, titling or registration.

EXCEPT TO THE EXTENT PROVIDED BY MANDATORY LAW, PROVIDER’S LIABILITY ARISING FROM OR RELATED TO THIS AGREEMENT SHALL BE LIMITED TO DIRECT DAMAGES AND SHALL NOT INCLUDE CONSEQUENTIAL, INDIRECT, EXEMPLARY OR PUNITIVE DAMAGES.

8. NOTICES

All notices required or permitted by this Agreement must be in writing and delivered to the parties at the addresses provided below. Notice shall be effective upon actual receipt or three (3) days after deposit in the U.S. mail, postage prepaid, or upon confirmed electronic delivery if sent to an email address provided by a party.

9. AMENDMENT, WAIVER, COUNTERPARTS

No amendment, modification or waiver of any provision of this Agreement shall be effective unless it is in writing and signed by both parties. No failure or delay by either party in exercising any right shall constitute a waiver of that right.

This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. Executed copies delivered by electronic transmission shall be binding upon the parties.

10. ENTIRE AGREEMENT; SEVERABILITY; GOVERNING LAW

This Agreement, together with any attachments, exhibits and acknowledgements signed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations and agreements. If any provision of this Agreement is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

This Agreement shall be governed by the laws of the state of without regard to conflict of law principles.

11. MISCELLANEOUS PROVISIONS

Applicant acknowledges receipt of a copy of this Agreement and understands that submission of this Application does not guarantee that Provider will be able to complete any requested filing without additional documentation or applicable fees.

Applicant certifies under penalty of perjury that the statements made in this Application are true and correct and that Applicant is authorized to make this Application for the Vehicle described herein.

ACKNOWLEDGEMENTS

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