HOME ACCEPTANCE CORPORATION

MERCHANT APPLICATION

APPLICANT’S BUSINESS INFORMATION

Organizational Structure:(Required)
Business Address
MM slash DD slash YYYY

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

MM slash DD slash YYYY
Address


MM slash DD slash YYYY
Address