DEALER PRINCIPAL IDENTIFICATION FORM

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DEALER PRINCIPAL IDENTIFICATION FORM LIST THE NAMES OF ALL EXECUTIVE OFFICERS, PRINCIPAL SHAREHOLDERS, PARTNERS, MEMBERS, AND / OR DIRECTORS, WHO OWN (10% OR MORE), CONTROL, OR HAVE THE POWER TO EXERCISE A CONTROLLING INFLUENCE OVER THE MANAGEMENT OR POLICIES OF THIS DEALERSHIP. Please note: This information is needed to comply with Santander Consumer USA AML Policies. Complete all fields or write “N/A” and fax to Special Ops (214)540–5597.

DEALER INFORMATION dealership name dealership street address city, state and zip dealership phone other phone

PERSON #1

PERSON #2

name

name

title

title

home address

home address

city, state and zip

city, state and zip

date of birth

date of birth

PERSON #3

PERSON #4

name

name

title

title

home address

home address

city, state and zip

city, state and zip

date of birth

date of birth

PERSON #5

PERSON #6

name

name

title

title

home address

home address

city, state and zip

city, state and zip

date of birth

date of birth

© 2012 SANTANDER CONSUMER USA INC. All Rights Reserved. // Confidential and Proprietary // SCUSA and Roadloans Dealer Agreement /Version 1.00 (042712)

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