AGREEMENT TO PROVIDE INSURANCE
This is to certify that_____________________________________________ has
auto insurance coverage with a $_____________ deductible with
_____________________________________________________________
(Insurance Agent)
_____________________________________________________________
(Address)
_____________________________________________________________
(Phone)
on the following vehicle:_________________________ Year, Make & Model
____________________________________________ Vehicle Identification No.
LIENHOLDER ADDRESS:
Santander Consumer USA Inc.
PO Box 47260
Atlanta, GA 30362-0260
Dealer Signature
Customer Signature
Insurance Valid as of
© 2009 SANTANDER CONSUMER USA INC. // P.O. BOX 560583 // DALLAS, TX 75356-0583 // 020209