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" Finance" Credit Application
Name of Business
Type of Business: Sole Owner Partnership Corp.
Business Phone
Fax
Email Address
Address
City
State Zip
County
Years in Business Fed ID#
Owner Name
Soc. Security
Home Owner Rent
Years at residence
Home Address
Home Phone
Cell Pager
Nearest Relative(Required)
Relation Phone
Primary Bank
Account #
Contact Name
Phone
Non Credit Card Business Reference
Employer (If employed outside of vending)
Position Salary $
Spouse's Employer
Position Salary$
Payment Preference
Automatic withdrawal Check/Billing Statement
Buyer authorizes Seller to obtain such information as required concerning the statements contained in the above application for credit and agrees that the application shall remain the Seller's property, is presented for approval only that final acceptance or rejection rest solely with the Seller and should Seller reject the application, Seller is relieved of any further obligation to Buyer
Position of Signer
Agreed Date(MM/DD/YY)
Please enter the types of machines and quantities you would like to finance:
