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Dealership Name: _________________________________________

Phone Number: ___________________________________________

Address: ________________________________________________________________________
Sales Reconciliation Exclusions:
Dealer Initials Agent Initials
□ Previous Sales History □ All □ Date Range
Prior to Date Range Exception - ___________________-___________/__________
□ Previous Service History □ All □ Date Range
Prior to Date Range Exception - ___________________-___________/__________

Description / Name Dealer Initials Agent Initials


□ Alternate Mktg Program -______________________-___________/___________

□ Alternate Mktg Program -______________________-___________/___________

□ Alternate Mktg Program -______________________-___________/___________

□ Lead Provider Program -______________________-___________/___________

□ Lead Provider Program -______________________-___________/___________

□ Lead Provider Program -______________________-___________/___________

□ CRM Tracking Program -______________________-___________/__________

Dealer Signature:______________________________Date:__________________

Dealer Printed Name:_________________________________________

Agent Signature: ______________________________Date:_________________


Agent Printed Name:__________________________________________

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