Vendor Application

Credit Application

What Dealership Are You Applying For

*First Name

*Last Name

*Phone

*Email

Comments

Business Information

Business Name

Phone/Fax

Federal Tax ID or Social Security Number

Type of Business

Number of Employees

Date Business Established

Type of Products You Will Purchase

Amount of Credit Requested

Other:

State where your company was organized

Have you or any of your affiliates ever had credit with us before? Yes No

If yes, under what name?

Name or title of persons authorized to act on your behalf

Reference #1 Name and Address:

Phone

Reference #2 Name and Address:

Phone

Bank References

Phone

By clicking this box, I agree to receive in-person or automated telemarketing calls and texts from The Khoury Group at the number I entered. I understand that my consent is not required for purchase.