Midas New Dealer Sign Up

Join the Everly Dealer Family! Tell Us More About Your Company.
Please provide all required details below to qualify your business with us. If your company qualifies to become a dealer, an Everly.Market representative will be in contact with you to discuss further. Thank you for your interest in Everly.Market
Business Legal Name*
Business DBA*
Business Owner*

First NameLast Name
Store Number*
Store E-mail*
Store Website*
Federal Tax ID#*
Store Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Corp Type
What year did you start your business*
What year did you start your business
YYYY
Social Security Number of Officer*
Residential Address of Officer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Name of Primary Finance Contact*
Email of Primary Finance Contact*
example@example.com
Primary contact mobile number*
Please enter a valid phone number.
Has your company ever filed bankruptcy?*

YesNo
Are you aware of any judgements or liens against your company?*

YesNo
What lenders do you have?*

SynchronyFortivaAcimaAmerican First FinanceSnapKafeneKornerstoneKatapultUownProgressiveKoalifi
What is your annual sales volume?*
What is your Average Ticket?*
Which finance companies are you currently using today?*
What areas need improvement to ensure your total finance solution is truly solving yourbusiness needs?
Please list the products that you service/sell.*
What Product or service do you sell?*

FurnitureMattressTire and rimsCell PhonePowersportsPC/laptopElectronicsAuto repairJewelryHome improvementDentistryCosmetic SurgeryBikesOther
Want to Credit Card?

YesNo
Want to Accept Crypto

YesNo
Want a Line of Credit?

YesNo
What Lenders would you like?*

US BankPaytomorrowAcimaAcima ExistingAmerican First FinanceAmerican First Finance ExistingUown
American First Finance Entity ID#
How many sales people do you have on your team?*
How many locations do you have?*
Copy of owner Drivers License

Cancelof
Copy of Business Certificate/License

Cancelof
Picture of inside of store

Cancelof
Picture of outside of store

Cancelof
Name of Bank*
Routing Number*
Account number*
Would you like to sign up for our free wholesale program?*

YesNo
Copy of voided check

Cancelof
Signature

Clear
Consumer Finance Application For Dealers
I authorize these consumer finance companies to verify the information provided and perform any
necessary due diligence including but not limited to checking personal and business references, credit
reports, fraud checks and similar resources. I individually, and as an officer of the company, hereby
warrant and represent that this and any other information provided to lenders is a complete and accurate
representation of the company and does not omit information that might negatively reflect the outcome of
this review or the ability of the company to operate.
Your Everly.Market team will work on the finance setup and onboarding as discussed. Next steps after this
submit are as follows:
-- Merchant agreements for approving finance companies
-- User IDs / access / security information for accessibility
-- Technical setup, training & launch date!
Should be Empty:

Join the Everly Dealer Family! Tell Us More About Your Company.