DLL Financial Solutions Partner Application For Credit
GENERAL
Email
*
example@example.com
APPLICANT’S NAME (Last, First, Middle)
*
SOCIAL SECURITY NO.
*
DATE OF BIRTH (MM/DD/YYYY)
*
/
Month
/
Day
Year
Date
TELEPHONE NUMBER
*
MAILING ADDRESS
*
Street Address Line 2
CITY
STATE
ZIP
PHYSICAL ADDRESS (IF DIFFERENT THAN MAILING)
Street Address Line 2
City
COUNTY AND STATE OF WHERE EQUIPMENT WILL BE KEPT
Postal / Zip Code
COUNTY (REQUIRED)
*
COUNTY AND STATE WHERE EQUIPMENT WILL BE KEPT
*
US CITIZEN
*
YES
NO
IF NO, PERMANENT RESIDENT
YES
NO
MARITAL STATUS
*
MARRIED
SEPARATED
UNMARRIED
DO YOU FARM?
*
FULL TIME
PART TIME
# OF ACRES OWNED/RENTED
*
EQUIPMENT USE (% percentage)
FARM
CUSTOM WORK
FORESTRY
CONSTRUCTION/COMMERCIAL
INDUSTRIAL
RENTAL YARD
PERSONAL/FAMILY/HOUSEHOLD
OTHER
IF % OTHER, PLEASE DESCRIBE
YEARS IN FARMING BUSINESS
*
BUSINESS or Co-Buyer(s)
LEGAL NAME UNDER WHICH YOU OPERATE IF PARTNERSHIP, LLC OR CORPORATIONS:
*
YEARS IN BUSINESS
*
FED TAX ID
*
ORGANIZATION ID
STATE OF ORGANIZATION
TYPE OF BUSINESS
LIMITED PARTNERSHIP
LIMITED LIABILITY COMPANY (LLC)
CORPORATION
INDIVIDUALGENERAL PARTNERSHIP
GENERAL PARTNERSHIP
OTHER (Please specify)
PRINCIPAL / OWNERSHIP INFORMATION
An individual (1) who owns, directly or indirectly, more than 25% of the equity interests or Profit Sharing/Economic interest of the legal entity customer (e.g., each natural person that owns more than 25% of the shares of a corporation); OR (2) the name of the natural person with effective control (day to day decision making) OR if neither (1) or (2) apply, please provide the names of all Board of Directors (BODs)/Executive Management. Ownership Type: Ownership, economic interest, voting rights or shares >25%Person who exercises effective control (BODs)/Executive Management
OWNERSHIP TYPE
*
Ownership, economic interest, voting rights or shares >25%
Person who exercises effective control
BODs/Executive Management
PRINCIPAL/OWNER
SOCIAL SEC NO. / TAX ID
ADDRESS (Including COUNTRY OF RESIDENCE)
DATE OF BIRTH
TELEPHONE
% OWNED
TITLE/POSITION
BANK INFO
PRIMARY LENDER NAME
*
CITY, STATE
*
TELEPHONE
*
Please enter a valid phone number.
CONTACT
*
Signature
(Individual)
Date
-
Month
-
Day
Year
Date
Signature
Title/Capacity (Indicate Partner/Officer/Manager/Guarantor)
Date
-
Month
-
Day
Year
CO-APPLICANT
Signature
(Individual)
Date
-
Month
-
Day
Year
Signature
Title/Capacity (Partner/Officer/Manager/Guarantor)
Date
-
Month
-
Day
Year
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