Bendele Technology Credit Application Form

Bendele Technology Credit Application Form

Please fill out this form to apply for credit. All information provided will be kept confidential. Your job is your credit.
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Item Description*
Residential Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth*

MonthDayYear
Date
Social Security Number*
Employed Full-TimeEmployed Part-TimeSelf-EmployedUnemployedStudentRetiredOther
Monthly Income (in USD)*
Please provide any additional information relevant to your credit application
Employer Name*
Employer Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Length of Employment (Years)*
Reference 1 (Family Member)*
Reference 1 Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference 1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2*
Reference 2 Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference 2 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3*
Reference 3 Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference 3 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
I agree to the terms and conditions of this credit application. The decision to grant payments on Bendele Technology items is at the sole discretion of Bendele Technology and not through any bank. If approved applicants must provide First month and Last month payment to start lease. Payment terms are 6 month, 12 month, or 18 month depending on the value of the item being leased. If for any reason you are unable to make your regular payments you agree to contact Bendele Technology and return the item with no penalty. At time of return if your device has personal data on it Bendele Technology will assist with putting your data onto a thumb drive so that none of your personal data is lost. Tech support is provided while in an active lease. At the end of the lease if all payments have been made the device is yours to keep. *
Should be Empty: