Rocky Mountain Acceptance

Size: px
Start display at page:

Download "Rocky Mountain Acceptance"

Transcription

1 Rocky Mountain Acceptance Your Local, Same Day Funding Source Dealer Credit Application / Credit Authorization Release Form The statements made below are true and correct and made by in order to induce Rocky Mountain Acceptance, LLC ( RMA ) or its assigns, to grant credit to and/or purchase automotive retail installment sale contracts from my dealership with the knowledge that RMA will rely thereon. I hereby authorize RMA to investigate and/or contact the references identified below without recourse to RMA or to the references provided. I authorize my credit reference(s) to release information to RMA as necessary for RMA to provide credit or purchase retail installment sale contracts from my dealership. Dealership Name (Legal Name): Dealership DBA: City: State: Zip: Telephone: Fax: Dealership Website: www. Type of Business (check one): Corporation LLC Partnership Limited Partnership Sole Proprietorship Fed. Tax ID# Do you utilize an electronic application platform? Vendor (Dlr. Track, Route One, Etc.) Vendor Number Individual(s) authorized to submit applications: Franchised Dealership: YES Franchise Name: NO Dealer License No. (DMV): Dealership Ownership (list all owners and percentage of business owned): 1. % 2. % 3. % 4. % Key Dealership Personnel (please list): GM F&I Mgr Bus Mgr GSM Spec F&I Title Clerk Years in Business: Number of Locations:

2 Dealership Facilities: Time at Current Location: Yrs. Mos. Facility Owned or Leased: Owned Leased Service Department/Repair Facility: Yes No Consignment Inventory: Yes No Affiliated Dealerships (through common ownership): Dealership Operational Profile Used New Avg. Monthly Sales (# of Vehicles): Vehicle Inventory: Avg. # Inventory: % of Inventory Owned: Avg. Vehicle Age: Avg. Wholesale Value: Avg. Sale Price Finance & Insurance: Finance Penetration: Avg. # of Non-Prime Contracts: Avg. Customer Cash Down Pmt: Warranty Penetration: Avg. Warranty Retail Price: Avg. Warranty Dlr. Cost: Warranties Sold: Other Finance Products Sold:

3 Dealership References Bank Reference(s): Bank: Bank: Current Credit References: Floor Plan Lender: Landlord/Mortgage Lender: Personal Reference 1: Relationship: Personal Reference 2: Relationship:

4 AUTHORIZATION TO RELEASE INFORMATION DEALERSHIP NAME: DEALER PRINCIPAL(S) NAME: 1. AUTHORIZATION FOR RELEASE: I/We hereby authorize (creditor/credit reference) to release and disclose to Rocky Mountain Acceptance, LLC, its subsidiaries, affiliates, employees, and agents, information pertaining to my/our credit rating or creditworthiness, including but not limited to business and consumer credit reports, and outstanding credit accounts (e.g. real estate mortgages, auto loans, personal loans, charge cards, credit union accounts, etc.). I hereby release (creditor/credit reference) from any liability for disclosing such information. 2. VALIDITY/REVOCATION: I/We understand that this release may be revoked by sending written notice to the person or entity authorized to release information related to my/our credit rating and creditworthiness. I/We agree that any release of information that was made prior to revocation and that was made in reliance on this authorization shall not constitute a violation of my/our right to privacy or confidentiality. I/We authorize the release of credit rating and creditworthiness information as indicated above. In addition, I/We agree that any reproduction of this Authorization made by reliable means (such as photocopy or facsimile) is equally binding and acceptable as the original. Dealership Name Dealer Principal Signature Dealer Principal Name

5 AUTHORIZATION TO RELEASE INFORMATION DEALERSHIP NAME: DEALER PRINCIPAL(S) NAME: 1. AUTHORIZATION FOR RELEASE: I/We hereby authorize Equifax, Experian and Trans Union to release and disclose to Rocky Mountain Acceptance, LLC, its subsidiaries, affiliates, employees, and agents, information pertaining to my/our credit rating or creditworthiness, including but not limited to business and consumer credit reports, and outstanding credit accounts (e.g. real estate mortgages, auto loans, personal loans, charge cards, credit union accounts, etc.). I hereby release Equifax, Experian and Trans Union from any liability for disclosing such information. 2. VALIDITY/REVOCATION: I/We understand that this release may be revoked by sending written notice to the person or entity authorized to release information related to my/our credit rating and creditworthiness. I/We agree that any release of information that was made prior to revocation and that was made in reliance on this authorization shall not constitute a violation of my/our right to privacy or confidentiality. I/We authorize the release of credit rating and creditworthiness information as indicated above. In addition, I/We agree that any reproduction of this Authorization made by reliable means (such as photocopy or facsimile) is equally binding and acceptable as the original. Dealership Name Dealer Principal Signature Dealer Principal Name Dealer Principal Social Security Number Dealer Principal Home Address Dealer Principal City, State, Zip Code

BUSINESS FINANCING APPLICATION

BUSINESS FINANCING APPLICATION BUSINESS FINANCING APPLICATION Referring Broker/Affiliate (if applicable) Business Name Contact Person: Email: Phone: Fax: TELL US ABOUT YOUR REQUEST Ref Code: Web. Amount Requested $ Minimum Amount Needed

More information

Thank you for your interest in signing up with Greater Access Financial. Enclosed you will find the following:

Thank you for your interest in signing up with Greater Access Financial. Enclosed you will find the following: 1766 W. San Carlos Street San Jose, CA 95128 408-282-9931 phone 408-282-9932 fax Thank you for your interest in signing up with Greater Access Financial. Enclosed you will find the following: Dealer Application

More information

BUSINESS LOAN APPLICATION

BUSINESS LOAN APPLICATION BUSINESS LOAN APPLICATION IMPORTANT INFORMATION: Federal law under the USA Patriot Act requires us to obtain sufficient information to verify your identity. You may be asked several questions and to provide

More information

APPLICATION CHECKLIST

APPLICATION CHECKLIST APPLICATION CHECKLIST 308 W. Parkwood, Ste 108-A Friendswood, Texas 77546 Ph: 281-482-5200 Fax: 281-482-1682 Toll free: 1-855-LOAN212 Loans@loans212.com The Following Items MUST be submitted in order to

More information

Thank you for your recent interest in establishing credit with our company.

Thank you for your recent interest in establishing credit with our company. Thank you for your recent interest in establishing credit with our company. Please download, complete, and sign the authorization below to release credit information. Upon completion please email docs

More information

Dealer Information Sheet

Dealer Information Sheet Dealer Information Sheet Dealer Name and Address Dealer Name (maximum 27 characters) Corporate Legal Name (if different) New Reactivate for DIS # Reason for Inactivation: [Select reason] RBC Number RBC

More information

This form is fill-able; please type in all of the required information, then print to sign, date, and initial.

This form is fill-able; please type in all of the required information, then print to sign, date, and initial. Instructions: This form is fill-able; please type in all of the required information, then print to sign, date, and initial. Fill out the Program Application (page 2-5) and the Billing Authorization Form

More information

Bank References By listing their names, you authorize us to contact them for the purpose of obtaining your credit status.

Bank References By listing their names, you authorize us to contact them for the purpose of obtaining your credit status. *ALL AREAS ARE REQUIRED TO BE COMPLETED- PLEASE FILL IN N/A FOR AREAS THAT DO NOT APPLY* This Application for Credit and Credit Agreement ( Application ) is executed and delivered to Triple-S Steel Supply,

More information

Purchase Order Financing Application

Purchase Order Financing Application Purchase Order Financing Application Requested Facility Size $ Referred by: Projected Annual Sales: $ Current Amount of Open A/R: $ GENERAL BUSINESS INFORMATION Legal Name(s) of Business: Trade Name(s)

More information

Business Loan Application

Business Loan Application Business Loan Application Business Name (exact legal name): General Information DBA (if applicable): Street Address of Principal Registered Office: City: State: Zip Code: County: Current Mailing Address

More information

FACTORING APPLICATION FORM

FACTORING APPLICATION FORM FACTORING APPLICATION FORM Application Date: Application Urgency: High Medium Low General Company Information Legal Name of Company*: as shown on the Articles of Incorporation, Partnership Agreement, or

More information

Small Business Loan Checklist (Loan Exposure up to $500,000 (1) )

Small Business Loan Checklist (Loan Exposure up to $500,000 (1) ) Small Business Loan Checklist (Loan Exposure up to 500,000 (1) ) Please complete, sign and date all documentation and financial information and submit a complete loan package to prevent any unnecessary

More information

3776 S.R. 93 N.E., Crooksville, OH Toll Free (866) * Phone (740) * Fax (740)

3776 S.R. 93 N.E., Crooksville, OH Toll Free (866) * Phone (740) * Fax (740) 3776 S.R. 93 N.E., Crooksville, OH 43731 Toll Free (866) 818-4435 * Phone (740) 982-3030 * Fax (740) 982-3055 www.valueautoauction.com Name of Dealer: Telephone ( ) (Legal Name if Different) Fax# ( ) (Hereinafter

More information

Spearfish Economic Development Corporation Community Capital Revolving Loan Fund. Application Information

Spearfish Economic Development Corporation Community Capital Revolving Loan Fund. Application Information Spearfish Economic Development Corporation Community Capital Revolving Loan Fund Application Information SEDC Revolving Loan Fund Application Information Spearfish Economic Development is a private non-profit

More information

Golf Stiffy Distributor Agreement. Dealer Agreement

Golf Stiffy Distributor Agreement. Dealer Agreement Golf Stiffy Distributor Agreement & Dealer Agreement THIS AGREEMENT is mutually agreed by Golf Stiffy (hereafter referred to as Company ) and the Distributor or Dealer (hereafter referred to as Dealer

More information

PERSONAL FINANCIAL STATEMENT

PERSONAL FINANCIAL STATEMENT OMB Approval No. 3245-0188 PERSONAL FINANCIAL STATEMENT U.S. SMALL BUSINESS ADMINISTRATION As of, 20 Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest

More information

Credit Application Fax to: to:

Credit Application Fax to: to: Credit Application Fax to: 215.618.0786 Email to: creditapps@pjponline.com CUSTOMER TRADE NAME FULL LEGAL BUSINESS NAME PHYSICAL ADDRESS CITY STATE ZIP Federal Tax I.D. #: MAILING ADDRESS CITY STATE ZIP

More information

CDP/SPAT Collaborative Shellfish Business Loan Program

CDP/SPAT Collaborative Shellfish Business Loan Program CDP/SPAT Collaborative Shellfish Business Loan Program Background: The CDP is a non-profit community development corporation working to promote economic growth and affordable housing on the Lower Cape.

More information

SBA 504 LOAN APPLICATION

SBA 504 LOAN APPLICATION 222 N. 32 nd Street, Suite 200 Billings, MT 59101 Phone (406) 869-8403 Fax (406) 256-6877 www.bigskyfinance.org Last Chance Helena, MT 59601 Phone (406) 441-5447 Fax (406) 256-6877 www.bigskyfinance.org

More information

Attorney Credit Application Package

Attorney Credit Application Package Attorney Credit Application Package 320 Old Country Rd., Ste 101 Attorney Credit Application (Please type or print all information. Answers requiring additional space submitted on separate pages.) Firm

More information

HERITAGE MORTGAGE CORPORATION

HERITAGE MORTGAGE CORPORATION HERITAGE MORTGAGE CORPORATION INFORMATION AUTHORIZATION To Whom It May Concern: I/We hereby authorize Heritage Mortgage Corporation to verify any information necessary in connection with the application

More information

Loan Application Checklist

Loan Application Checklist If you have questions or need assistance completing the application, please contact the Community Economic Development Department at 260-423-3546 ext. 563 Loan Application Checklist For All Loans Signed

More information

THANK YOU FOR YOUR INTEREST IN BILL HICKS & CO., LTD

THANK YOU FOR YOUR INTEREST IN BILL HICKS & CO., LTD BILL HICKS & CO., LTD. Office: (763) 476-6200 15155 23 RD Avenue North Fax: (763) 476-8963 Minneapolis, Minnesota 55447-4740 Toll Free: (800) 223-0702 THANK YOU FOR YOUR INTEREST IN BILL HICKS & CO., LTD

More information

SBA 504 Loan Application

SBA 504 Loan Application SBA 504 Loan Application Questions regarding the Loan Application? Contact the BDC @ 574-288-5758 All sections of this application must be executed and provided to the BDC before a loan can be processed.

More information

UNIVERSAL LENDERS LLC

UNIVERSAL LENDERS LLC Agent Presentation About Universal Lenders and the ZERO Plan Strategy to Increase Dealership Profit and Agent Commission Step by Step. The ZERO Plan Process Fees and Funding Sample Transactions www.the-zero-plan.com

More information

AUTHORIZED INDEPENDENT AGENCY APPLICATION (PAGE 1)

AUTHORIZED INDEPENDENT AGENCY APPLICATION (PAGE 1) AUTHORIZED INDEPENDENT AGENCY APPLICATION (PAGE 1) Name of Brokerage or Agency as Licensed Date Address (street, city, state, zip) Telephone Mailing Address or "Trade Name" if Different than Above Individual

More information

SMA Customer Information & Application Agreement

SMA Customer Information & Application Agreement Date: SMA Customer Information & Application Agreement Send Completed Form To: P.O. Box 2247 Jonesboro, AR 72402-2247 870-935-5651 ar@smalink.com Select One New Customer Request Add Ship-To Location Update

More information

Registration Application

Registration Application Registration Application Dealership Information Dealership AuctionACCESS ID: Trade or DBA Name: Legal Name (if different): Date Business Started: Federal ID: RIN (Canadian Province of Ontario only): (US-EIN,

More information

Section 5 MEMBER SPOUSE In the last 2 years have you or your Spouse been unable to perform the full-time duties of your occupation for 10 consecutive

Section 5 MEMBER SPOUSE In the last 2 years have you or your Spouse been unable to perform the full-time duties of your occupation for 10 consecutive HARTFORD LIFE INSURANCE COMPANY Hartford, Connecticut 06155 National Active and Retired Federal Employees Association AGL-1545 Spouse's Name: (First, Middle Initial, Last), if applying Section 4 Amount

More information

BORROWER DISCLOSURES and PRIVACY POLICY

BORROWER DISCLOSURES and PRIVACY POLICY BORROWER DISCLOSURES and PRIVACY POLICY BORROWER CERTIFICATION AND AUTHORIZATION The undersigned certify the following: I/We have applied for a mortgage loan from In applying for the loan, I/We completed

More information

- CALIFORNIA - Used Car Dealership Items Needed to Register to BUY with ABS

- CALIFORNIA - Used Car Dealership Items Needed to Register to BUY with ABS - CALIFORNIA - Used Car Dealership Items Needed to Register to BUY with ABS 1) Dealer Registration Application Form 2) Authorization Form 3) California Resale Certificate 4) W-9 Form 5) Copies of Dealer

More information

Kemba Commercial Loan Application

Kemba Commercial Loan Application Kemba Commercial Loan Application GENERAL BUSINESS INFORMATION Applicant: DBA: Business Address: Business Phone: Legal Status:! Individual(s)! Corporation (C Corp)! LLC! LP/LLP! S Corp! Other: Date Founded:

More information

RGI GROUP, INC. We specialize in Business & Commercial Real Estate Financing

RGI GROUP, INC. We specialize in Business & Commercial Real Estate Financing RGI GROUP, INC. COMMERCIAL REAL ESTATE APPLICATION We specialize in Business & Commercial Real Estate Financing Commercial Includes: Land, Developments, Ranches, Churches w/ Daycares, 5+ Units (Full Doc,

More information

Business Account Application and Beneficial Owners Certification

Business Account Application and Beneficial Owners Certification Business Account Application and Beneficial Owners Certification IMPORTANT INFORMATION ABOUT PROCEDURE(S) FOR OPENING A NEW ACCOUNT: To help the government fight financial crime, the funding of terrorism

More information

ADDENDUM TO DEALER AGREEMENT

ADDENDUM TO DEALER AGREEMENT ADDENDUM TO DEALER AGREEMENT This Addendum to Dealer Agreement is entered into as of this day of,, for the benefit of R.C. Mast, INC.. (hereinafter referred to as ASC ), by (hereinafter referred to as

More information

APPLICATION FOR SMALL BUSINESS LOAN

APPLICATION FOR SMALL BUSINESS LOAN APPLICATION FOR SMALL BUSINESS LOAN Please return this form with the applicable credit report fees. We cannot consider any loan request that is not accompanied by a completed application. COMPANY INFORMATION

More information

Lift Works, Inc. Credit Application

Lift Works, Inc. Credit Application Credit Application 600 Industrial Dr ~ St. Charles, IL 60174 AR PH: (630) 957-4317 AR FX: (630) 957-4193 Main PH: (630) 833-4626 Main FX: (630) 833-4628 Complete Credit Application Form and fax to (630)

More information

APPLICATION FOR REVOLVING CREDIT

APPLICATION FOR REVOLVING CREDIT APPLICATION FOR REVOLVING CREDIT CFE Location: CFE Contact: THIS BUSINESS CREDIT APPLICATION (THE APPLICATION ) RELATES TO BUSINESS CREDIT ONLY. IF APPROVED, CREDIT WILL BE EXTENDED BY COOPERATIVE FARMERS

More information

Commissions. Bonuses

Commissions. Bonuses Commissions Delaware Lottery Retailers receive a five percent (5%) sales commission for selling tickets for all games allowed by their license type. In addition, Retailers are paid one percent (1%) commission

More information

PO Box 420 Alcoa, TN Date: Dealer Name: Date Organized: Type of Business: Ind. Corp. Partnership New Used Wholesale Request to: Buy Sell Both

PO Box 420 Alcoa, TN Date: Dealer Name: Date Organized: Type of Business: Ind. Corp. Partnership New Used Wholesale Request to: Buy Sell Both Thank you for your interest in doing business at Airport Auto Auction. Here is a registration package for your convenience which upon completion can be faxed back to us at 865-970-9603 or e-mail to krissybradford@airportautoauction.com.

More information

RELIGIOUS ORGANIZATION LOAN APPLICATION

RELIGIOUS ORGANIZATION LOAN APPLICATION RELIGIOUS ORGANIZATION LOAN APPLICATION Points Requested Do you have an outside fee agreement? Church Contact Person Phone Fax Email Name of Church/Organization Phone Fax Email Address City State Zip Organization

More information

Funding Checklist REQUIRED DOCUMENTS LIENHOLDER / LOSS PAYEE: PO Box 465 YOUR APPROVAL IS OUR BUSINESS!

Funding Checklist REQUIRED DOCUMENTS LIENHOLDER / LOSS PAYEE: PO Box 465 YOUR APPROVAL IS OUR BUSINESS! Funding Checklist Toll Free (866) 425-4220 Fax (866) 425-4226 Application Number: Dealership Name: Date: Dealer Contact: Phone Number: Buyers Last Name: Vehicle: Dealer Documents REQUIRED DOCUMENTS Retail

More information

Republic Business License Application

Republic Business License Application Republic Please answer all questions completely. Incomplete and unsigned applications will delay processing. All business licenses expire on December 31 st and must be renewed prior to that date. Date:

More information

*SLA LICENSE SERIAL #: *NY STATE TAX ID #:

*SLA LICENSE SERIAL #: *NY STATE TAX ID #: SOUTHERN GLAZER S WINE & SPIRITS OF UPSTATE NEW YORK, LLC P.O. BOX 4705 SYRACUSE, NEW YORK 13221-4705 PHONE: (315) 428-2100 FAX: (315) 410-5463 ACCOUNT # For office use only APPLICATION AND CREDIT AGREEMENT

More information

BUSINESS MEMBERSHIP APPLICATION

BUSINESS MEMBERSHIP APPLICATION FOR CREDIT UNION USE ONLY BUSINESS MEMBERSHIP APPLICATION Instructions and General Information Please review and complete the following information. Your Business Membership cannot be processed without

More information

VIATICAL SETTLEMENT APPLICATION

VIATICAL SETTLEMENT APPLICATION VIATICAL SETTLEMENT APPLICATION A. PERSONAL INFORMATION - (PRINT OR TYPE) Name of Insured: Male Female Date of Birth: SSN: Address: City: State: Zip: Telephone Number: Email Address: Marital Status: Single/Never

More information

LOAN OFFICER NAME: OFFICE PHONE: CELL PHONE: FAX: ADDRESS: AFFILIATE NAME: COMPANY NAME: BROKER NAME: BROKER PHONE: BROKER

LOAN OFFICER NAME: OFFICE PHONE: CELL PHONE: FAX:  ADDRESS: AFFILIATE NAME: COMPANY NAME: BROKER NAME: BROKER PHONE: BROKER Loan Application Complete the entire application. Failure to complete can cause delays in funding 701 E. Front Ave., Floor, Coeur d'alene, ID 83814 LOAN OFFICER NAME: OFFICE PHONE: CELL PHONE: FAX: EMAIL

More information

PERSONAL FINANCIAL STATEMENT for National Equity Funding. Federal law requires all financial institutions obtain,

PERSONAL FINANCIAL STATEMENT for National Equity Funding. Federal law requires all financial institutions obtain, PERSONAL FINANCIAL STATEMENT for National Equity Funding Federal law requires all financial institutions obtain, verify and record information that identifies each person who opens an account. When you

More information

REPURCHASE FACILITY APPLICATION

REPURCHASE FACILITY APPLICATION Facility Amount Requested: REPURCHASE FACILITY APPLICATION Company Information Company Name: DBA Names: Address: Street: City: State: Zip: Contact Person: Title: Telephone Number: Fax Number: E-mail Address:

More information

Business Loan Application Package

Business Loan Application Package Business Loan Application Package The items listed below are being requested in addition to the enclosed forms 2 Years Personal Tax Returns Business Financials Interim 2 Years Business Tax Returns Copy

More information

FAX COVERSHEET PLEASE FIND ATTACHED: Agency Appointment Forms. VIP Roadside Assistance Forms. ACH form for sweep set up Voided Check

FAX COVERSHEET PLEASE FIND ATTACHED: Agency Appointment Forms. VIP Roadside Assistance Forms. ACH form for sweep set up Voided Check FAX COVERSHEET TO: FAX NUMBER: 816-817-1621 FROM: AGENCY NAME: Date: Pages: PLEASE FIND ATTACHED: Agency Appointment Forms VIP Roadside Assistance Forms ACH form for sweep set up Voided Check ACH form

More information

MANUFACTURED HOME LOAN APPLICATION CHECKLIST

MANUFACTURED HOME LOAN APPLICATION CHECKLIST MANUFACTURED HOME LOAN APPLICATION CHECKLIST The information requested on this form is necessary to process your manufactured home loan application. PLEASE PROVIDE THE FOLLOWING DOCUMENTATION: A copy of

More information

WELCOME TO YOUR NEW APARTMENT! Date APPLICATION FOR RESIDENCY

WELCOME TO YOUR NEW APARTMENT! Date APPLICATION FOR RESIDENCY WELCOME TO YOUR NEW APARTMENT! APPLICATION FOR RESIDENCY APT# ADDRESS RENT TENTATIVE M/I DATE LEASE TERM PERSONAL INFORMATION PLEASE PRINT FULL NAME HOME PH: ( ) LAST FIRST MIDDLE INIT DO YOU HAVE A PET?

More information

Purpose (use of funds) Collateral: Unsecured Real Estate Vehicle Accounts Receivable Inventory Equipment Deposits/Securities Other (Describe)

Purpose (use of funds) Collateral: Unsecured Real Estate Vehicle Accounts Receivable Inventory Equipment Deposits/Securities Other (Describe) It's fast and easy to apply for a Business Express Loan or Business Express Line of Credit. Before visiting one of our Banking Centers to submit your application, please gather the following required documents

More information

Business Licensing Packet

Business Licensing Packet Business Licensing Packet Vehicle Dealer License Application Instructions Thank you for your interest in obtaining a Maryland Vehicle Dealers License. It is our intent to help you obtain your license as

More information

RESIDENTIAL LOAN PACKAGE SUBMISSION CHECKLIST

RESIDENTIAL LOAN PACKAGE SUBMISSION CHECKLIST COGO Capital 1121 E Mullan Ave Coeur d Alene, ID 83814 1311 Phone: 1-800-473-6051 x Fax:888-897-0237 BKoder@cogocapital.com RESIDENTIAL LOAN PACKAGE SUBMISSION CHECKLIST COGO Capital has the ability to

More information

Black Hills Community Economic Development 504 Loan Application

Black Hills Community Economic Development 504 Loan Application Black Hills Community Economic Development 504 Loan Application Company Information Company Name: Address: City: State: Zip: Principal in Charge: Phone: Fax: Secondary Contact Person: Phone: Fax: Email

More information

INVESTOR PRESENTATION

INVESTOR PRESENTATION INVESTOR PRESENTATION DISCLOSURE 2 Forward-Looking Statements This presentation includes forward-looking statements within the meaning of the "Safe-Harbor" provisions of the Private Securities Litigation

More information

BECK EQUIPMENT, INC Preble Rd, Preble, NY Toll Free: (866) / Fax: (607)

BECK EQUIPMENT, INC Preble Rd, Preble, NY Toll Free: (866) / Fax: (607) Legal Company Name BECK EQUIPMENT, INC. RENTAL APPLICATION To apply for rentals from Beck Equipment, Inc., please provide the following information. Fill out completely and return by fax to (607) 749-5640.

More information

Micro Loan Application ($5000 or Less)

Micro Loan Application ($5000 or Less) NORTHERN SHORES LOAN FUND, INC. Micro Loan Application ($5000 or Less) This form is designed to provide NSLF with enough information to fully consider your loan request. A fully completed application will

More information

SBA 504 LOAN APPLICATION

SBA 504 LOAN APPLICATION 222 N. 32 nd Street, Suite 200 Billings, MT 59101 Phone (406) 869-8403 Fax (406) 256-6877 www.bigskyfinance.org 825 Great Northern Blvd, Ste 301 Helena, MT 59601 Phone (406) 441-5447 Fax (406) 449-5678

More information

* Corporation General Partnership Limited Partnership LLC Sole Proprietorship Non Profit Other Accounts Payable: Name

* Corporation General Partnership Limited Partnership LLC Sole Proprietorship Non Profit Other Accounts Payable: Name INVACARE CORPORATION New Customer Change of Ownership Customer Credit Application *Legal Name of Business Trade Name (DBA) *Billing Address: Shipping Address (if different): *Federal Tax ID # * # of Years

More information

TCH Development, LLC

TCH Development, LLC TCH Development, LLC RELIGIOUS ORGANIZATION LOAN APPLICATION If your church is seeking to expand or refinance we may be able to help! We occupy a unique position in church financing, with the capability

More information

Tax Services. To see if you qualify for these products, you agree to do the following steps

Tax Services. To see if you qualify for these products, you agree to do the following steps Tax Services Tax Services Agreement This Agreement represents Taxpayer s authorization for A+ Tax Services, a registered trade name of (A+ Bookkeepers, Inc.,) to take the following actions: (1) Complete

More information

Dealer Profile Information

Dealer Profile Information Dealer Checklist/Profile Sheet: 2017 Dealership Name: The following checklist is to ensure that you fill out and send back the correct paperwork to Global Lending Services. If you have any questions, please

More information

Customer Account Information Form Please fill up clearly in BLOCK LETTERS.

Customer Account Information Form Please fill up clearly in BLOCK LETTERS. Customer Account Information Form Please fill up clearly in BLOCK LETTERS. ABCSI is a trading participant of the Philippines Stock Exchange, Inc., member of SCCP and SIPF. PERSONAL ACCOUNT Account Code

More information

PLEASE TYPE OR PRINT LEGIBLY

PLEASE TYPE OR PRINT LEGIBLY PHOTOCOPY, FILL OUT, AND SEND. RETAIN THE BLANK ORIGINAL FOR FUTURE USE. SOCIAL MARKETER INFORMATION: PLEASE PRINT SOCIAL MARKETER SOCIAL MARKETER ID OF CORPORATION, PARTNERSHIP, TRUST, OR OTHER COMPANY

More information

Registration Application

Registration Application Registration Application Dealership Information Trade or DBA Name: Legal Name (if different): Date Business Started: Federal ID: RIN (Canadian Province of Ontario only): (US-EIN, MX-RFC, CA-GST/BIN, International-Owners

More information

CITY OF KENT, OHIO DEPARTMENT OF COMMUNITY DEVELOPMENT LOAN APPLICATION COMMERCIAL/INDUSTRIAL LOAN PROGRAMS

CITY OF KENT, OHIO DEPARTMENT OF COMMUNITY DEVELOPMENT LOAN APPLICATION COMMERCIAL/INDUSTRIAL LOAN PROGRAMS CITY OF KENT, OHIO DEPARTMENT OF COMMUNITY DEVELOPMENT LOAN APPLICATION COMMERCIAL/INDUSTRIAL LOAN PROGRAMS This application form will be used by applicants seeking funding under the City's Commercial

More information

Wholesale Financing Options for a Competitive Advantage

Wholesale Financing Options for a Competitive Advantage Wholesale Financing Options for a Competitive Advantage With a wholesale financing program through Doosan Global Finance, Doosan dealers automatically get a competitive advantage by having more equipment

More information

JOINT ACCOUNT. Last Name: First Name: Initial: Date of Birth: Street Address: City, State, Zip: County:

JOINT ACCOUNT. Last Name: First Name: Initial: Date of Birth: Street Address: City, State, Zip: County: CREDIT APPLICATION Location submitting application: MFA OIL COMPANY MFA PETROLEUM COMPANY One Ray Young Drive Columbia, MO 65201 INDIVIDUAL ACCOUNT Complete Parts 1, 4 and 5 if you are applying for an

More information

BUSINESS LOAN APPLICATION. Note: We encourage you to speak with a loan officer before submitting a loan application.

BUSINESS LOAN APPLICATION. Note: We encourage you to speak with a loan officer before submitting a loan application. Mailing address: PO Box 342, Barre, VT 05641 Physical address: 105 N. Main St. Barre, VT 05641 Tel: 802-479-0167 Fax: 802-476-1926 Building Communities, One Vermont Business At A Time www.communitycapitalvt.org

More information

Application for Commercial Real Estate Loan

Application for Commercial Real Estate Loan Application for Commercial Real Estate Loan Branch: Customer/Borrower Legal Name: Date Physical Street Address: City State CA Fed Tax ID No. Social Security Zip Telephone No. Fax No. Individual Corporation

More information

Franchise Application

Franchise Application Franchise Application U-Save Car Sales, Inc. reserves the right to approve or disapprove the Franchise Application, and Applicant shall not be deemed to have been granted a franchise to operate a U-Save

More information

Direct Deposit Setup Instructions:

Direct Deposit Setup Instructions: Direct Deposit Setup Instructions: 1. Provide IRS Letter of Incorporation or State Business Registration Certificate. 2. Complete the following forms for the Company setup, please ensure that you sign

More information

ADDITIONAL INSTRUCTIONS FOR A FCSTONE, LLC ACCOUNT MANAGED BY A THIRD PARTY

ADDITIONAL INSTRUCTIONS FOR A FCSTONE, LLC ACCOUNT MANAGED BY A THIRD PARTY ADDITIONAL INSTRUCTIONS FOR A FCSTONE, LLC ACCOUNT MANAGED BY A THIRD PARTY 1. If you are opening an FCStone, LLC account to be directed or managed by a third party; whether or not they are registered

More information

JOEL D. FOSTER DPM, PC AUTHORIZATION TO RELEASE MEDICAL BENEFITS

JOEL D. FOSTER DPM, PC AUTHORIZATION TO RELEASE MEDICAL BENEFITS JOEL D. FOSTER DPM, PC AUTHORIZATION TO RELEASE MEDICAL BENEFITS I authorize the release of all medical information necessary to process insurance claim(s) and I hereby assign and authorize direct payment

More information

M O D E L R E C T I F I E R C O R P O R A T I O N 80 NEWFIELD AVENUE FAX: EDISON, NEW JERSEY USA TEL:

M O D E L R E C T I F I E R C O R P O R A T I O N 80 NEWFIELD AVENUE FAX: EDISON, NEW JERSEY USA TEL: EDISON, NEW JERSEY 08837-3817 USA TEL: 732-225-2100 Dear Hobby Retailer: First and foremost, we would like to thank you for choosing MRC. You will undoubtedly find that MRC products and services will meet

More information

LOAN OFFICER NAME: OFFICE PHONE: CELL PHONE: FAX: ADDRESS: AFFILIATE NAME: COMPANY NAME: BROKER NAME: BROKER PHONE: BROKER

LOAN OFFICER NAME: OFFICE PHONE: CELL PHONE: FAX:  ADDRESS: AFFILIATE NAME: COMPANY NAME: BROKER NAME: BROKER PHONE: BROKER Loan Application Complete the entire application. Failure to complete can cause delays in funding 701 E. Front Ave., Floor, Coeur d'alene, ID 83814 LOAN OFFICER NAME: OFFICE PHONE: CELL PHONE: FAX: EMAIL

More information

CONVENTIONAL / SBA LOAN APPLICATION BUSINESS LOAN APPLICATION CHECKLIST

CONVENTIONAL / SBA LOAN APPLICATION BUSINESS LOAN APPLICATION CHECKLIST CONVENTIONAL / SBA LOAN APPLICATION BUSINESS LOAN APPLICATION CHECKLIST Please use this checklist as a guide to the documentation necessary to complete the processing of your business loan. If certain

More information

BUSINESS AND INDUSTRY LOAN FUND APPLICATION

BUSINESS AND INDUSTRY LOAN FUND APPLICATION BUSINESS AND INDUSTRY LOAN FUND APPLICATION Applicant/business name: Address: APPLICANT INFORMATION City: State: ZIP code: Contact person: Phone: E-mail: Type of Business: Sole Proprietorship Corporation

More information

**For Your Convenience We Also Accept Checks By Fax And Credit Card Payments**

**For Your Convenience We Also Accept Checks By Fax And Credit Card Payments** Revised 10-27-2014 SIGNATURE SPRINGS, LLC B I L L ATTENTION Account Information Form S H I P LEGAL BUSINESS NAME ADDRESS T O TRADE NAME KITCHEN CONTACT ADDRESS T O CITY, STATE, ZIP ACCOUNTING CONTACT PHONE

More information

SpencerFlex Line of Credit Disclosure

SpencerFlex Line of Credit Disclosure Disclosure IMPORTANT TERMS OF OUR SPENCERFLEX HOME EQUITY LINE OF CREDIT Retention of Information: This disclosure contains important information about our Home Equity Line of Credit. You should read it

More information

New Customer Package. Credit Application Contact Sheet Insurance Requirements (with example)

New Customer Package. Credit Application Contact Sheet Insurance Requirements (with example) New Customer Package Credit Application Contact Sheet Insurance Requirements (with example) Please fill out the downloaded forms and provide a certificate of insurance complying with all of the requirements

More information

Q4'15 COMPANY UPDATE

Q4'15 COMPANY UPDATE Q4'15 COMPANY UPDATE 1 LITHIA MOTORS FEBRUARY 2016 DISCLOSURE Forward-Looking Statements This presentation includes forward-looking statements within the meaning of the "Safe-Harbor" provisions of the

More information

INVESTOR PRESENTATION

INVESTOR PRESENTATION INVESTOR PRESENTATION 1 LITHIA MOTORS APRIL 2016 DISCLOSURE Forward-Looking Statements This presentation includes forward-looking statements within the meaning of the "Safe-Harbor" provisions of the Private

More information

2019 FALKEN FANATIC PROGRAM DEALER ENROLLMENT APPLICATION

2019 FALKEN FANATIC PROGRAM DEALER ENROLLMENT APPLICATION 2019 FALKEN FANATIC PROGRAM DEALER ENROLLMENT APPLICATION DEALER INFORMATION Date Dealer Name Dealer Address City State Zip Code For Official Use Only Associate Dealer Number Number of Locations Dealer

More information

Alger Insurance and Consulting LLC Commercial Lending Application

Alger Insurance and Consulting LLC Commercial Lending Application Alger Insurance and Consulting LLC Commercial Lending Application COMMERCIAL LOAN APPLICATION This checklist is provided to assist in gathering the necessary information needed for the initial evaluation

More information

GETTING TO KNOW YOU. 1. How important is it for you to keep your teeth healthy for a lifetime?

GETTING TO KNOW YOU. 1. How important is it for you to keep your teeth healthy for a lifetime? Robert W. Renger, D.D.S., L.L.C. 510 W. 32 nd St. Joplin, MO 64804 417-781-6700 GETTING TO KNOW YOU 1. How important is it for you to keep your teeth healthy for a lifetime? 2. If you could change one

More information

DATE APPLICANT/GUARANTOR SIGNATURE APPLICANT/GUARANTOR (PLEASE PRINT) APPLICANT/GUARANTOR (PLEASE PRINT) APPLICANT/GUARANTOR SIGNATURE DATE

DATE APPLICANT/GUARANTOR SIGNATURE APPLICANT/GUARANTOR (PLEASE PRINT) APPLICANT/GUARANTOR (PLEASE PRINT) APPLICANT/GUARANTOR SIGNATURE DATE = By checking this box and submitting this form, in connection with this loan application and any update, extension or modification, the undersigned authorizes the Lender to make all inquiries it deems

More information

Business Financing Application. (Note: If any sections herein are described in your business plan, please insert See B/P page ) Your Business Name:

Business Financing Application. (Note: If any sections herein are described in your business plan, please insert See B/P page ) Your Business Name: NBFDC Nickel Basin Federal Development Corporation Société fédérale de développement du Bassin de Nickel Place Tom Davies Square, 200 Brady, Sudbury ON P3E 5K3 Tel: 705-673-9802 Fax: 705-673-7722 Business

More information

Welcome to Monoprice, Inc.

Welcome to Monoprice, Inc. Welcome to Monoprice, Inc. Enclosed is Monoprice, Inc. Account Application Form. Please complete the application form and send it back to our sales department. Once you have become our customer, you can

More information

Humana Insurance Company Hospital Indemnity Claim Filing Instructions

Humana Insurance Company Hospital Indemnity Claim Filing Instructions Humana Insurance Company Hospital Indemnity Claim Filing Instructions Page 1 Insured s Statement of Claim: Must be completed each time you file a claim. Be sure to answer every question. Page 2 Authorization

More information

DEALERSHIP: NEW OR USED CAR(S)

DEALERSHIP: NEW OR USED CAR(S) Salt Lake City Area Office 8722 S. Harrison St. Sandy, UT 84070 P.O. Box 4439 Sandy, UT 84091 800-257-5590 Fax 800-478-9880 Chicago Office 303 W. Madison Street Suite 2075 Chicago, IL 60606 800-456-4576

More information

Legal first and last name of person being assessed today: Marital Status: Social Security #: State: Zip: Employer:

Legal first and last name of person being assessed today: Marital Status: Social Security #: State: Zip: Employer: Admissions Staff Place Patient ID Sticker Here Patient Registration Please read and complete both sides of this form Date: Time: Legal first and last name of person being assessed today: Date of Birth:

More information

State of the Automotive Finance Market

State of the Automotive Finance Market State of the Automotive Finance Market A look at loans and leases in Q4 2016 Presented by: Melinda Zabritski Sr. Director, Financial Solutions www.experian.com/automotive 2016 Experian Information Solutions,

More information

Copeland s of New Orleans 1001 Harimaw Ct. S. Metairie, LA , Phone , Fax

Copeland s of New Orleans 1001 Harimaw Ct. S. Metairie, LA , Phone , Fax Copeland s of New Orleans 1001 Harimaw Ct. S. Metairie, LA 70001 504-620-3740, Phone 504-620-2016, Fax gslavich@alcopeland.com 1 FRANCHISE EVALUATION PROCEDURE Al Copeland Investments, Inc. would like

More information

Capitol-Husting Company, Inc. /Allstate Liquor & Wine Co.

Capitol-Husting Company, Inc. /Allstate Liquor & Wine Co. Capitol-Husting Company, Inc. /Allstate Liquor & Wine Co. Wholesalers Importers of Liquor and Wine CAPITOL-HUSTING COMPANY INC. ALLSTATE LIQUOR & WINE CO., INC. 12001 WEST CARMEN AVENUE 12005 WEST CARMEN

More information

PEO Insurance Brokers Network looks forward to doing business with your agency and beginning a great working relationship.

PEO Insurance Brokers Network looks forward to doing business with your agency and beginning a great working relationship. Dear Referral Partner: PEO Insurance Brokers Network looks forward to doing business with your agency and beginning a great working relationship. CHECKLIST Legible copy of your current broker s license

More information

990 Cherry Ave Suite 204, Long Beach Ca Direct Fax TRW International CUSTOMER AGREEMENT

990 Cherry Ave Suite 204, Long Beach Ca Direct Fax TRW International CUSTOMER AGREEMENT TRW International CUSTOMER AGREEMENT Please make check payable to: TRW Credit Services TRW-9417 APPLICANTS PERSONAL INFORMATION Name (Last, First, Middle Initial) Social Security Number Mailing Address

More information