Credit Application
Upon completion of Application you will receive further information and we will contact you soon
Put N/A for the fields that are not applicable to you
Rep Name:
Business information:
Business Name:
DBA:
Business Phone:
Address:
City:
State:
Zip:
Federal Tax ID:
Date Business Started:
Employees #:
Industry:
Vehicles in the Fleet:
Years of Experience:
Legal Structure:
Previous Finance Sources:
Previous credit issues:
Monthly Gross Income:
Average ending Balance:
Owner Details:
First Name:
Middle Name:
Last Name:
Email:
Title:
Phone:
Ownership Percentage:
Social Security #:
Date of Birth:
Home Address:
City:
State:
Zip:
Owner 2 (optional):
First Name:
Middle Name:
Last Name:
Email:
Title:
Phone:
Ownership Percentage:
Social Security #:
Date of Birth:
Home Address:
City:
State:
Zip:
Credit Information:
Past due Child Support or Had any Repos in the last 3 years?
Do you have an Open bankruptcy or Are you past due any mortgage or Are you past due on any auto loans?
Additional Information:
Equipment:
Sales Price:
Down Payment Amount:
Term:
Previous or Affiliate Companies:
Haul Reference:
Dealer Name:
Notes:
Acknowledge:
By clicking 'Submit; on behalf of themselves and the applicant, the applicant and the Owners/Partners/Members/Guarantors agree as follows: They certify that all information provided is true, correct and complete and that the property leased or acquired with any credit provided will be used solely for business and commercial purposes. Providing email addresses authorizes JAYMA Qualified / Affiliated Dealers to email information about financing, Promotions, and other offers. The applicant and the Owners/Partners/Members/Guarantors of the applicant listed above recognize that their individual credit histories may be a factor in the evaluation of the applicant for the credit it is applying for and, thus, authorize JAYMA Qualified / Affiliated Dealers or its designee to investigate their organizational and personal credit histories. This includes obtaining information from all sources including using their consumer credit reports in the credit evaluation and collection processes and to update any such information periodically and, If the application tor credit is approved, share such information with financing partners and professional advisors
You will be contacted after completion of the form
CUSTOM JAVASCRIPT / HTML
Copyright 2022 - Jayma Qualified - All Rights Reserved