Heavy Equipment Dealership Credit Application
Business Information
Business Name
DBA (if applicable)
Street Address
City
State
ZIP Code
Phone Number
Fax Number
Email
Federal Tax ID
State Tax ID
Business Type
Corporation
Partnership
Sole Proprietorship
LLC
Other
Years in Business
Principal(s)/Owner(s) Information
Full Name
Title
SSN
Address
City
State
ZIP Code
Ownership %
Phone
Bank Reference
Bank Name
Branch
Contact Name
Phone
Account Number
Trade References
Company Name
Contact Name
Phone
Account Number
Email
Company Name
Contact Name
Phone
Account Number
Email
Credit Request
Amount of Credit Requested
Reason for Credit Request
Authorization
By signing below, I/we authorize the release of credit information to the dealership for the purpose of establishing an open account line of credit:
Signature
Date