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Credit Application
Have us contact you with information, or complete the application below for approval with no obligation!
1.) Please contact me with information:

Name:

Phone #:
2.) Yes, please accept my completed application form! 
......I understand that I am under no obligation.  I will fax to 1-770-951-2007..

Application for Credit
COMPANY

Legal Business Name
Address
City  State  Zip
Contact
Title
Phone
Email:
 
Business Structure
S.Corp
Part
 
Type Business
# Funerals
Years in Business
 
Principals  
Name
SS#
DOB
% Owned
Address
Phone
 
Name
SS#
DOB
% Owned
Address
Phone
 

Have you ever filed bankruptcy?

If yes, explain

Have you ever been a defendant in any suit or legal action?
 
General credit information on a business is required to reach a credit decision. In some circumstances we will require limited business financial information in order to complete a credit decision. I hereby authorize you to obtain any information that you may require concerning statements given herein including personal credit bureau reports on all individuals involved.

NOTICE OF OUR PRIVACY PRACTICES
The US Congress passed the Gramm-Leach-Biley Act, which deals in part with how financial institutions treat non-public personal financial information. We are committed to preserving our customers' confidentiality and want to take this opportunity to inform you of our privacy practices as they relate to non-public personal financial information.
In conducting our business, we obtain certain non-public personal financial information about you. This includes information we receive from you on applications or other forms, your financial transactions with us, our affiliated or others, and information we may receive from a consumer reporting agency.
Access to this information is restricted to individuals who need this information to provide service and products to you.
The information is protected by physical, electronic and procedural safeguards.
We do not disclose this information about you or any former customers to anyone, except as permitted by law.
The law permits us to share this information with our affiliated and non-affiliates for specified purposes, specifically to obtain financing approval for funeral equipment.
Authorized Signature and Title (For faxing only)
__________________________________________ (Sign)
________________________________________________(Title)
Date________________

Click the SEND! button to electronically submit, 
or print this form, sign it and fax it to:
Fax 1-770-951-2007

The nation's largest and oldest provider of vehicle and
equipment financing for the funeral industry!
1-800-452-6224
5085 Magnolia Bluff Dr.
Atlanta, GA 30350