Credit Application

Applicant Information


Business Information

Owner Information (Partner, Proprietor and/or Guarantor)

Vendor Information

Equipment

Review

Applicant Information
Full Legal Business Name
DBA
Address
Business Phone Number
City
State
Zip Code
Contact Full Name
Contact Title
Contact Email
Contact Phone Number
Business Information
Business Nature
Business Website
Business Fax
Business Type
Number of Employees
Year Business Incorporated/ Established
Business State
Owner Information
First Name
Last Name
Title
SSN
***-**-****
Ownership Percentage
Address
City
State
Zip Code
Vendor Information
Vendor Contact Name
Vendor Contact Email
Vendor Contact Phone
Equipment
Equipment Description
Monthly Payment ($)
Requested Term (Months)
Finance Amount ($)
Upload Supporting Documentation
Digital Signature

By submitting this application, Vendor, by and through the representative of Vendor who is transmitting this application, hereby represents to Account Services Processing Center (“Account Services”) that: (1) all of the information contained in the above-referenced application is true and correct to the best of Vendor’s knowledge, (2) in the event Vendor later discovers that any of the above information is incorrect, Vendor will promptly submit to Account Services a new application with the correct information, and (3) Vendor is submitting the above application on behalf of the business listed above (the “Applicant”) for the purpose of obtaining commercial credit. Additionally, for any individual listed above under Owner Information (“Owner”), Vendor, by and through the representative of Vendor who is transmitting this application, represents to Account Services that the Owner has expressly authorized Vendor to investigate the financial stability of Applicant and/or Owner, and to obtain information from any credit reporting agency relating to Applicant and/or Owner in connection with Account Services extending credit to Applicant and/or reviewing/collecting the account.

The Equal Credit Opportunity Act disclosure for the Applicant can be found here.

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