HOME ACCEPTANCE CORPORATION

MERCHANT APPLICATION

APPLICANT’S BUSINESS INFORMATION

Organizational Structure:(Required)
Business Address
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If a Corporation - Officers: (Name if applicable)

If LLC, Member managed or Manager Managed

APPLICANT’S BANK REFERENCES

APPLICANT’S LANDLORD/MORTGAGE REFERENCES (if property is owned, please attach copy of mortgage statement)

Business Facilities
If Leasing Property

ADDITIONAL APPLICANT INFORMATION (Business)

GENERAL APPLICANT INFORMATION

Do you own Real Estate?
Do you own vehicles and/or Machinery?
Marketing/Sales Methods Used
Do you currently offer a financing program?

If Yes, please complete the following

Are regular financial statements prepared?
Has your company ever filed bankruptcy?
Has there been a recent (within the last 2 years) change in majority shareholders and/or officers?
Has your company ever been involved in litigation?
Is your company or any of its principals an endorser or guarantor?

APPLICANT’S PRINCIPAL INFORMATION

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Address
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Address
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Address

The undersigned certifies that all information provided herein is true and correct and hereby authorizes HOME ACCEPTANCE CORPORATION and any credit bureau or other agency to investigate the references, statements, or other data listed or accompanying this Dealer application. The undersigned authorizes all the parties’ contacts to release credit and financial information requested as a part of any due diligence. All of the above information will be relied upon by Home Acceptance Corporation for the purpose of applying for approval as a Dealer with Home Acceptance Corporation. The undersigned understands that Home Acceptance Corporation will retain this application whether or not the applicant is approved as a Dealer.

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Merchant Application Checklist

We will send you a secured file to upload all the required documents.

Please provide the following items (if applicable) to initiate approval and setup:
The below items may be requested: