Loanstar Application

Step 1 of 5

Business Information

TO GREAT DANE OF UTAH, INC AND/OR ITS ASSIGNESS, FOR THE PURPOSE OF OBTAINING CREDIT FROM YOU, OR AS A BASIS OF CREDIT FOR FUTURE BUSINESS, THE FOLLOWING COMPLETE STATEMENT IS MADE: IT IS AGREED THAT I / WE WILL NOTIFY YOU PROMPTLY, SHOULD THERE BE ANY MATERIAL CHANGE IN MY FINANCIAL CONDITION OR FINANCIAL CONDITION OF THE BUSINESS.

What business is applying for credit?(Required)

Legal Business Name

Business Type(Required)

Email Address(Required)

Enter Email Confirm Email

Business Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Federal Tax ID(Required)

No hyphens. Only numbers.

Phone #(Required)

Fax #

Business Start Date

Website

Person to Contact(Required)

First Last

Person to Contact Title(Required)

Business Principal 1

Principal 1 - Name(Required)

First Last

Principal 1 - Title(Required)

Principal 1 - Social Security #(Required)

No hyphens. Only numbers.

Principal 1 - % of Ownership(Required)

Principal 1 - Phone #(Required)

Principal 1 - Birthdate(Required)

Principal 1 - Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Principal 2

Principal 2 - Name

First Last

Principal 2 - Title

Principal 2 - Social Security #

No hyphens. Only numbers.

Principal 2 - % of Ownership

Principal 2 - Phone #

Principal 2 - Birthdate

Principal 2 - Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

References

Haul Reference Name / Company(Required)

First Last

Haul Reference Phone #(Required)

Trade / Finance Reference

Reference 1 - Name(Required)

Name

Reference 1 - Account #(Required)

Reference 1 - Phone #(Required)

Reference 1 - Contact Name

First Last

Reference 2 - Name

Name

Reference 2 - Account #

Reference 2 - Phone #

Reference 2 - Contact Name

First Last

Accounts Payable

Do you require a purchase order?(Required)

Yes

Person Authorized to Make Purchases(Required)

First Last

Authorized Person - Phone #(Required)

Accounts Payable Contact Name(Required)

First Last

Accounts Payable - Phone #(Required)

Guarantor

The undersigned, for consideration do hereby individually and personally guarantee the full and prompt payment of all indebtedness heretofore or hereafter incurred by the above business. This guarantee shall not be affected by the amount of credit extended or any change in the form of said indebtedness. Notice of the acceptance of this guarantee, extension of credit, modification in terms of payment, and any right or demand to proceed against the principal debtor is hereby waived. This guarantee may only be revoked by written notice which shall be sent to the creditor's credit office by certified mail. Any revocation does not revoke the obligation of the guarantors to provide payment for indebtedness incurred prior to the revocation. I authorize the seller and their assigns to obtain a consumer credit report and to contact my references as necessary.

Guarantor 1 - Name

First Last

Guarantor 1 - Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Guarantor 1 - Birthdate

Guarantor 1 - Social Security #

No hyphens. Only numbers.

Guarantor 1 - Signature

Guarantor 2 - Name

First Last

Guarantor 2 - Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Guarantor 2 - Birthdate

Guarantor 2 - Social Security #

No hyphens. Only numbers.

Guarantor 2 - Signature(Required)

Authorization

Applicant Name(Required)

First Last

Applicant Title(Required)

Applicant Signature - 1 of 2(Required)

Applicant Signature - 2 of 2(Required)

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex marital status, age provided the applicant has the capacity to enter into a binding contract because all or part of the applicants income derives from any public assistance program or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administer compliance with this law or concerning this creditor is: Federal Trade Commission, Equal Credit Opportunity, Washington, DC

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