Business Credit Application Form
Authorized Employee Information
Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Title/Position
Social Security #
Ownership %
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Owners Name (if applicable)
Additional Owners % of Ownership (if applicable)
Additional Owners Social Security # (if applicable)
Company Information
Legal Business Name
DBA (if applicable)
Legal Structure of Business
Tax I.D. Number
In Business Since :
-
Month
-
Day
Year
Date
Annual Revenue
Please Select
New Business or Entity
Up to $100,000
$100,001 - $250,000
$250,001 - 500,000
$500,001 - $1,000,000
Over $1,000,000
Number of Employees
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Bank Information
Required for some of our business lenders
Bank Name
ex. Chase
Account #
Equipment & Financing Information
Amount to Finance
Vehicle Description
Contact Person
First Name
Last Name
Contact Person Phone Number
-
Area Code
Phone Number
Authorized Signer
First Name
Last Name
Title
Terms & Conditions
You understand and agree that you are applying for credit by providing the information to complete and submit this credit application. We may keep this application and any other application submitted to us and information about you whether or not the application is approved. You certify that the information on the application and in any other application submitted to us, is true and complete. You understand that false statements may subject you to criminal penalties. The words "you," "your" and "yours" mean each person submitting this application. The words "we," "us," "our" and "ours" as used below refer to us, the dealer, and to the financial institution(s) selected to receive your application. You authorize us to submit this application and any other application submitted in connection with the proposed transaction to the financial institutions disclosed to you by us the dealers. This application and any other application submitted in connection with proposed transaction to the financial institutions disclosed to you by us the dealers. This application will be reviewed by such financial institutions on behalf of themselves and us the dealer. In addition, in accordance with the Fair Credit Reporting Act, you authorize that such financial institutions may submit your applications to other financial institutions for the purpose of fulfilling your request to apply for credit. You agree that we may obtain a consumer credit report periodically from one or more consumer reporting agencies (credit bureaus) in connection with proposed transaction and any update, renewal, refinancing, modification or extension of that transaction. You also agree that we or any affiliate of ours may obtain one or more consumer credit reports on you at any time whatsoever. If you ask, you will be told whether a credit report was requested, and if so, the name and address of any credit bureau from which we or our affiliate obtained your credit report. you agree that we may verify your employment, pay, assets and debts, and that anyone receiving a copy of this is authorized to provide us with such information. You further authorize us to gather whatever credit and employment history we consider necessary and appropriate in evaluating this application and any other applications submitted in connection with the proposed transaction. You understand that we will rely on the information in this credit application in order to assist in financing.
Signature
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