Name (First, Middle, Last) Social Security Number Driver’s License Number/State
- - /
Home Address (Street, City, State, Zip Code)
Business Address (Street, City, State, Zip Code)
Home Telephone Number Business Telephone Number
( ) ( )
Years School Degree Major
List any other education or training you believe will be helpful for your ownership or operation of a Nissan dealership.
Have you ever been employed, in any capacity, by a Nissan or Infiniti Dealer? NO YES
If YES, please complete below.
Period From/To Dealer Name Dealer Address
Do you now own, operate, or have a financial interest in or have you previously owned, operated or had a financial interest in any automobile
dealership? NO YES If YES, please complete below.
Name of Dealership Vehicle Lines Financial
Title/Position Reason for
Attach current and prior year-end financial statement, customer satisfaction and sales
performance reports for each manufacturer listed above.
Application for Nissan Dealer Sales and Service Agreement 1 of 7