Credit Application
Dealer Information
Company Legal Name
*
Dealership Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Phone Number
*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
*
example@example.com
In Business Since
*
-
Month
-
Day
Year
Date
Choose one.
*
Corporation
LLC
Sole Proprietorship
Partnership
FEIN#
*
Do you Own, Rent, or Lease your Lot?
*
Own
Rent
Lease
Landlord / Mortgage Holder Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Brands you currently sell:
*
Select the Product(s) You Are Interested in Floor Planning
*
Trailers
Golf Carts
Mowers
Tractors
RVs
Business Owner Information 1
Owner/Officer Name
*
First Name
Last Name
SSN
*
Date of Birth
*
-
Month
-
Day
Year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
*
Please enter a valid phone number.
Cell Phone (if different from Primary Phone)
*
Please enter a valid phone number.
Business Owner Information 2 (if applicable)
Owner/Officer Name
First Name
Last Name
SSN
Date of Birth
-
Month
-
Day
Year
Date
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
Please enter a valid phone number.
Cell Phone (if different from Primary Phone)
Please enter a valid phone number.
References
Name of Nearest Relative
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Vendors
*
Bank Reference
*
Phone Number
*
Please enter a valid phone number.
Insurance Agent
*
Phone Number
*
Please enter a valid phone number.
Choose one.
*
Full Coverage
Liability
How did you hear about us?
*
Please Select
Website
Social Media
Search Engine
Word of Mouth
Other
Disclaimer
Everything that I have stated in this application is correct and true to the best ofmy knowledge. I understand that you will retain this application whether or not it isapproved. I am informed that you or your agent may request a consumer report inconnection with this application and that, if I ask you, you will inform me if such areport was requested, and the name and address of the consumer reportingagency that furnished the report. I am also informed that subsequent reports maybe requested, or used, in connection with any update, renewal or extension of thecredit applied for. You are authorized to check my credit and employment historyas well as any other credit investigation you deem necessary and to answerquestions about your credit experience with me. I also authorize you to contactany of my trade reference/creditors for the purpose of among other things,obtaining inter-credit agreements.
Signature of Applicant 1
*
Signature of Applicant 2 (if applicable)
Date
*
-
Month
-
Day
Year
Date
Submit
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