INSTRUCTIONS:


  • Try to use three trade references which pay within terms, and with whom you have had a relationship for at least two years, if possible avoid COD accounts.

  • Make sure you provide a two year banking history. If your present bank account is less than two years old, please provide previous bank information, including account no.'s, even if the account is now closed. We MUST be able to track your banking history for a minimum of two years.

  • Click Done and print the completed form. Then, please sign the Release Authorization and fax the entire form to LimosDirect at 732-972-5570. Due to law enforcement of the privacy act, most banks and suppliers require a signed authorization prior to furnishing credit information.

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Confirm/Print
LimosDirect Credit Application
Business Name
DBA Name
Business Entity
Tax ID
Email
Mailing Address 1
Mailing Address 2
City
State
ZIP Code
Phone
Fax
Business Type
LimosDirect Credit Application
Business Name:   Business Entity:
DBA:   Tax ID:
Mailing Address:   Email:
Phone Number:   Fax:
Type of Business:      
 
Credit Information
Bank 1:
Account #: Phone #: Officer:
 
Bank 2:
Account #: Phone #: Officer:
 
Bank 3:
Account #: Phone #: Officer:
 
Trade References/Suppliers (Two Year History)
Name: Phone #: Contact:
Name: Phone #: Contact:
Name: Phone #: Contact:
Insurance: Phone #: Contact:
 
Principal Information
Name:   Name 2:
Address:   Address 2:
Phone #:   Phone # 2:
SSN:   SSN 2:
 
Equipment
Equipment:   Model Year:
Price:   Sales Representative: LimosDirect
 
Authorization for Release
The information in this application is true and correct to the best of my knowledge. I authorize Limosdirect.net to forward this application on my behalf to entities designated as preferred partners, who offer differing financial service products. I further authorize these entities to request information from me, and/or the entity I represent, and make inquires considered necessary and appropriate, including requesting a credit report from reporting agencies for the purposes of offering financial services products for which I, or the entity which I represent, may qualify, or any other lawful purpose. The independent entities comprising Limosdirct.net preferred partners will rely on the information in deciding whether, or not, to grand the credit request.

Please sign the Release Authorization and fax to LimosDirect at 732-786-0031.

  For the purpose of securing lease or other financing, I authorize all deposit and borrowing information to be released by telephone or fax.
 
__________________________________________________
Individual Name:
 
__________________________________________________
Business Name:
 
__________________________________________________
Signature:
 
Date: