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Client Financing
Financing Solutions For Your Products & Services
Client Financing
Financing Solutions For Your Products & Services
CDL merchant application
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CDL merchant application
CDL merchant application form
Step
1
of
4
25%
Personal Information
First Name
Middle Name
Last Name
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Own or Rent
OWN
RENT
OTHER
Time At Address
o
1
2
3
4
5
6
7
8
9
10+
*Time shown in years. If 0-11 months, select 0 yrs.
Housing Payment
Marital Status
Divorced
Married
Single
Separated
Widowed
DOB
mm/dd/yyyy
SSN
Phone Number
EXAMPLE: 5551113434 (No Dashes)
Email Address
Income/Employment Information
Employed By
Self
Others
Employer Name
If you are self employed, list "your name" as the Employer.
Occupation / Title
What is your job title or the industry you work in?
Phone Number
EXAMPLE: 5551113434 (No Dashes)
Length of Employment
0
1
2
3
4
5
6
7
8
9
10+
*Time shown in years. If 0-11 months, select 0 yrs.
Employer Address
City
State
Example: WY
Zip Code
Average Income
Income Period
MONTH
YEAR
Payment Information
We collect two (2) forms of payment; Credit/Debit Card & ACH.
Bank Name
Account Number
Routing Number
Account Type
Checking
Savings
Payment Information (Card)
We collect two (2) forms of payment; Credit/Debit Card & ACH.
Name
(Required)
First
Last
Card Number
Card Brand
Visa
MasterCard
Discover
Amex
Card Type
Credit
Debit
Month
(Required)
January
February
March
April
May
June
July
August
September
October
November
December
Year
(Required)
2023
2024
2025
2026
2027
2028
2029
2030
CVV
(Required)
Two References
Please provide two references. They will be no outreach to the references provided unless the customer defaults on payments and avoids all collection efforts.
Reference #1
First Name
(Required)
Last Name
(Required)
Phone Number
(Required)
EXAMPLE: 5551113434 (No Dashes)
Relationship
(Required)
Parent
Grandparent
Sibling
Spouse
Significant Other
Friend
Co-Worker
Child
In-Law
Cousin
Aunt
Uncle
Other
Reference #2
First Name
(Required)
Last Name
(Required)
Phone Number
(Required)
EXAMPLE: 5551113434 (No Dashes)
Relationship
(Required)
Parent
Grandparent
Sibling
Spouse
Significant Other
Friend
Co-Worker
Child
In-Law
Cousin
Aunt
Uncle
Other
Service/product cost
Brief description of the services/products you provide