Form Page - DMJ Networking

Finance Application

Thank you for your application. We will review your submission and be in touch soon. Please note the fields marked with an asterisk (*) that are required.

Business Details

Business Legal Name*

Doing Business As (DBA)

Business Start Date*

Date Of Ownership*

Federal Tax ID*

Number Of Calls Per Year*

Number Of Employees*

Annual Revenue*

Type of Business*

Business Structure*

Billing Address*

Apt/Ste

City*

State*

Zip*

Contact Name*

Email*

Phone Number*

WEF Customer Number

First Principal Owner

First Name*

Middle*

Last Name*

Suffix

SSN

Date of Birth*

Percent Owned*

Title*

Home Address*

City*

State*

Zip*

Primary Phone Number*

Is there a second principal owner?*

Bank Reference

Bank Name*

Contact Person*

City*

State*

Phone Number*

Equipment to Finance

Vendor Name

Contact Person

Phone Number

Type of Equipment*

Model

Description

New

Used

Additional Equipment

Replacement Equipment

Equipment Cost*

Trade-In Amount*

Trade-In Owed*

Cash Down Payment*

Financing Needed*

Requested Term*

Insurance

Insurance for the above equipment. (Insurance is REQUIRED on all equipment financed.)

Agent Name*

Company Name*

Phone Number*Name*

Policy Number*

Terms & Conditions

Certification and Authorization for Credit Application: For the purpose of obtaining credit, I (We) affirm that all information provided in this application is accurate and complete. I (We) grant permission to American Heat Processing (AHP) to verify all details included in this application, which may involve obtaining credit reports and contacting references. This authorization applies both to the initial credit application and throughout the duration of the lease/finance agreement. I (We) release and waive any claims against AHP and the listed references for any actions or omissions during this verification process.
Customer Identification Program: To assist the government in combating terrorism financing and money laundering, Federal Law mandates that all financial institutions must collect, verify, and record information identifying each individual who opens an account. This means that when you open an account, you will be asked for your name, address, date of birth, and other identifying information. Additionally, you may be required to present your driver's license or other identification documents. Typing your name in the respective signature fields signifies your acceptance of these terms and conditions.

Signature*

Title*

Date*