Extended Protection Dealer Profile

D ealer P rofile

DEALERSHIP NFORMATION Dealership Business Associate Code (BAC) Dealership Corporate Name Dealership d/b/a Address City

State*

Zip Code

Email Phone

Fax

Franchise(s) Represented Dealer Principal

General Manager

F & I Manager

Office Manager

FIXED OPS INFORMATION Service Manager

Service Phone

Retail Labor Rate $

Per Hour

Preferred Shop Manual

SECURITY ADMINISTRATION INFORMATION The Security Administrator is responsible for creation, assignment and maintenance of all User ID’s for the Online system for the dealership. The Security Administrator will have FULL visibility to all systems set-up information for the dealership. A temporary password will be emailed to the designated Security Administrator upon the Administrator’s completion of dealership installation. Administrator Name Title Phone Email

GMF DRM Name

ID #

Programs Installed l Protection Plan Vehicle Service Contract l Tire and Wheel Protection l Guaranteed Automobile Protection (GAP) (Some states utilize specific forms)

E-MAIL TO:

programheadquarters@extendedprotectiononline.com

TOLL-FREE FAX TO: (877) 264-9705

66GEP0513

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