ONLINE VENDOR INFORMATION FORM
Fields marked in BOLD are required in order for your form to be processed.
 
Account Rep.           Mon 2017 Sep 25 @ 14:36

DEALER PROFILE
Business Name:
Business Address:         Floor/Suite:
City:   State:   Zip:     Phone:
Owner(s):
Equipment Types Sold:
Type of Business: Proprietorship    Partnership    Corporation    Other
Federal Tax #:     Resale Certificate #:
Year Business Began:     Annual Sales: $
Annual Leasing: $     Expected Leasing to SBC: $

PERSONAL INFORMATION ON OWNER(S) / STOCKHOLDERS
Name:    Title:
Social Security #:       % of Ownership:
Home Address:         Floor/Suite/Apt:
City:   State:   Zip:     Phone:
E-mail:
Name:    Title:
Social Security #:       % of Ownership:
Home Address:         Floor/Suite/Apt:
City:   State:   Zip:     Phone:

BANK INFORMATION
Bank Name:     Branch:
Phone:         Bank Officer:
Business Checking Account #:
Loan Account #:

TRADES
Supplier:     Contact:
Supplier Address:         Floor/Suite:
City:   State:   Zip:     Phone:
Supplier:     Contact:
Supplier Address:         Floor/Suite:
City:   State:   Zip:     Phone:

I hereby authorize our bank, trade references, and financial institutions to release
        all credit information to Smart Business Credit.

 


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