| | | | | |       New Recovery Agent Signup   Name:* Address:* City:* State:*   Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Zip Code:* - Phone Number:* Fax Number:* E-Mail address: Territory Covered:   Mileage From Agency: Counties or Cities Covered: Zip Code: Other:         Our Minimum Insurance Requirements: 1. $1 Million in General Liability 2. $1 Million in Auto Liability (Must be named as additional insured and state if a repossession) 3. Adequate Worker's Compensation Flat Fees Proposed by Agent for Remarketing Solutions:     Repossessed-Involuntary     Repossessed-Voluntary     Repossessed-Skip     Cure     Closes      Recommended System Requirements: Pentium Processor Monitor w/1024x768 resolution Preferred browser - Microsoft Internet Explorer 5.x or above Preferred Connection - ISDN or DSL Manheim | Cox Enterprises

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