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Commercial Credit Application
Applying for:
Purchase:
Lease:
Business Start Date
Tax Id #
Business Type
Please Select
C Corp
S Corp
LLC
Partnership
Sole Proprietorship
State of Incorporation (if applicable)
Legal Business Name
DBA Name
Address
City
State
Zip Code
Phone Number
Fax Number
Principal Owner / Guarantor Name
Title
Social Security #
Home Address
Home City
State
Zip Code
Ownership %
Time With Co.
Years Experience
Mo. Income
Email Address
Principal Owner / Guarantor Name
Title
Social Security #
Home Address
Home City
State
Zip Code
Ownership %
Time With Co.
Years Experience
Mo. Income
Email Address
Bank Reference
Account #
Contact Name
Bank Reference
Account #
Contact Name
Vehicle Insurance Co.
Policy #
Contact Name
AUTHORIZATION TO RELEASE CREDIT INFORMATION
The undersigned states that all of the information contained herein or provided in connection with this Application is true and correct and accurately describes the financial condition of the Customer(s) as of the date hereof: and I will notify DaimlerChrysler Financial Services Americas LLC, its successors and assigns if I become aware of any material change in the financial condition of the Customer(s). I hereby authorize Creditor and or Dealer to make inquiry into, to request, and to receive any information concerning my financial condition, including, but not limited to, obtaining a credit report and contacting any current or former creditors of Customer(s) to verify any information contained herein or received in connection with this Application, which Creditor and/or Dealer deems relevant to the possible extension of credit to Customer(s) ("Information").
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