Credit Application-End-User
*
Required fields
Company Information
*
Legal Company Name:
Type of Business:
- Select -
Corporation
LLC
Nonprofit
Partnership
Proprietorship
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Date Business Started:
Federal ID #:
*
Nature of Business:
Website:
*
Contact Name:
*
Phone
:
Cell Phone:
*
Email:
*
Own Equipment Location:
- Select -
YES
NO
Number of Employees:
*
Physical Address:
*
City:
*
State:
*
Zip:
Equipment Location:
City:
State:
Zip:
Bank Information
*
Name of Bank:
*
Average 3 Month Balance:
Principal Information
For Nonprofit Entities, enter N/A in required fields
First Name:
Last Name:
Title:
Ownership %:
Social Security #:
Home Address:
City:
State:
Zip:
Home Phone #:
Cell Phone #:
Principal2 Information
(If more than 20%)
First Name:
Last Name:
Title:
Ownership %:
Social Security #:
Home Address:
City:
State:
Zip:
Home Phone #:
Cell Phone #:
Other Information
*
Horizon Keystone Consultant:
Not Sure
Bill Waddell
Carla Kuni
Corinne Beyer
Dan Harkin
Irene Duffy
Janeen Waddell
Jennifer Dougan
Jessica Kopytko
Jim Wall
Kevin Karol
Kim Stroemel
Tracy Fagan
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Equipment Description:
Audio/Video
Automotive
Computer (Hardware/Software)
Construction
Furniture
Generators
Lifts
Lighting
Medical
Printing
Refrigeration
Security Systems
Signs
Telecommunications
Used Equipment
Walls
HVAC
Other
*
Equipment Cost:
Dealer Name (if known):
Contact :
Phone :
Submitting this application electronically shall have the same force and effect as if the application bore inked original signature(s). The undersigned individual as principal of and/or guarantor for the applicant, authorizes Horizon Keystone Financial, its designee, assigns or potential assigns, to review his/her personal credit profile provided by national credit bureaus in considering this application and for the purpose of the update, renewal, or extension of credit to the applicant or the collection of any resultant accounts. By checking this box, you agree to the terms and conditions.
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Name (authorized signature):
Title:
Promo Code:
