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Online Application - AFLLC


*FULL LEGAL NAME for business entity

*Company TIN/EIN

*Year business established

*Business Address – Practice Location(STREET CITY STATE ZIP )

*Business Telephone Number

*Business Fax Number



To help the government fight the funding of terrorism and money laundering activities, U.S. Federal law requires financial institutions to obtain, verify, and record information that identifies each person (individuals and businesses) who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.


*Principal’s Name

*Home Address (street)

*Home Telephone Number

*Mobile Telephone Number

*E-Mail Address

*Social Security Number

*Amount Requested

Comments



Certification and Authorization of Individual(s) to Release Information: The undersigned person, individually and on behalf of the above Applicant (collectively the “Signer”), hereby represents to Americorp Financial, LLC, its subsidiaries and affiliates (collectively “AFLLC”) that (a) all information provided to AFLLC in connection with this credit application, including, without limitation, tax returns, financial statements, accountants’ statements and the information set forth above, is true and correct and (b) this credit application is made solely in connection with a commercial (and not a personal, family or household) transaction. Signer hereby authorizes AFLLC and any of its affiliates and potential or actual assignees to obtain any business and/or personal financial information, from time to time, including, without limitation, information from any consumer reporting agency, credit bureau or other reporting source regarding Signer’s and/or Applicant’s credit history, for purposes of (i) evaluating this application, (ii) monitoring any and all leases, loans and other financial transactions entered into as a result of this application, (iii) extending, renewing or amending any such lease, loan or other contract, and/or (iv) evaluating any request by Signer or Applicant for additional credit in the future. Signer hereby authorizes and instructs any consumer reporting agency, financial institution and other persons or entities possessing information about Signer and/or Applicant to furnish AFLLC with all such information in response to an inquiry from AFLLC and any of its affiliates and potential or actual assignees both now and at any time in the future. You understand that you may apply for credit in your name alone, regardless of your marital status.



ADA, AMA and AAHA will have no involvement in either the credit approval process or the terms of any lease, loan or other contract.


*Signed

*Print Name

*Title

Co-Applicants or Guarantors should each complete and sign a separate application


By checking this box, I hereby authorise our bank consumer agencies , trade references, and financial institutions to compile and furnish any information pertainng to our credits and financial responsibilities as requested by AMERICORP FINANCIAL, LLC or its assigns and photostatic, fascimile or other electronic copies of its authorization may be submitted to obtain the release of its information





* Required Field
An Americorp Financial, LLC Representative will contact you shortly
Please do not hesitate to contact us with any question
Email Us at info@vantagedr.com

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