Business Credit Application

Business Credit Application
Authorized Principal Information
Name*

PrefixFirst NameLast Name
Title/Position*
Phone Number*
Date of Birth*
Social Security Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorized Principal Information
Name

PrefixFirst NameLast Name
Title/Position
Phone Number
Date of Birth
Social Security Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Information
Name of Company*
Type of Business*
Tax I.D. Number*
Years in Business*

MonthDayYear
Date
Number of Employees*
Business Phone Number*
State of Incorporation*
Fleet Size*
Previous Years Gross*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank References
Institution Name
Checking Account #
Contact Person

First NameLast Name
Contact Person Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Seller Information
Vender Name*
Contact Name*

First NameLast Name
Phone Number*
New or Used*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Equipment and Description*
Where equipment will be located

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount of Credit Requested*
Sale Price*
Term Requested
Financial Information
Company Total Assets*
Annual Net İncome*
Have you or your officers or affilates ever filed a petition in bancruptcy?*

YesNo
If so, describe
Is your company subject to any litigation?

YesNo
If so, describe
Terms & Conditions

“The personal information may be gathered and used by its assignees and potential assignees, to provide products and to perform services as may be requested by you. We may also disclose your personal information to third parties such as the vendor of your equipment, credit reporting agencies, financial institutions of financing companies, your insurance agent or company and/or companies which provide or insure warranties relating to your equipment. You are entitled to access this information that you provide and you may ask that it be updated and rectified. I acknowledge that the information, including personal information, may be processed and stored outside of the USA. We may also disclose your personal information where we are permitted by law to do so. By signing this document below, you have consented to these uses and disclosures.”
Company Name*
Authorized Employee*

PrefixFirst NameMiddle NameLast Name
Employee Title*
Signature*

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Authorized Employee*

PrefixFirst NameMiddle NameLast Name
Employee Title*
Signature*

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Business Credit Application

Authorized Principal Information

Authorized Principal Information

Company Information

Bank References

Seller Information

Financial Information