USA Dealer Power Up Binder - Flipbook - Page 46
Joel Schuman
DEALER PROFILE
Phone: 866-806-8021
Email: joel.schuman@westernequipmentfinance.com
DEALER
Business Name:
Contact Name:
Address:
Federal Tax ID #:
City:
State:
Phone Number:
Fax Number:
Zip:
Cell Number:
Equipment Product:
Website Address:
E-mail Address:
Years In Business:
Price Range:
ELECTRONIC FUNDS PAYMENT AGREEMENT
Business Name of Deposit Account:
Contact Name:
Bank Name:
Address:
Bank ABA/Routing # (9 digits):
Bank Account #:
Checking
Savings
Please attach a copy of a VOIDED check from the account payments will be made to:
Please check preferred payment method:
Wire
ACH
For purposes of obtaining Dealer approval, I (we) certify that all the information in this application is true and correct. I (we) grant permission to Western
Equipment Finance, Inc. to verify all information in this application and to provide any information requested by my (our) other creditors. I (we) also grant
permission to those creditors to provide all information requested by Western Equipment Finance, Inc. I (we) release and waive all claims against
Western Equipment Finance, Inc. and my (our) other creditors for all acts or omissions which occur in verifying the above information.
Business Name
Signature/Title/Date
MA9044 R121112
Signature/Title/Date
E-mail to: Sales@WesternEquipmentFinance.com | Fax to: (800) 215-6799
PO Box 640 - 503 Hwy 2 West Devils Lake, ND 58301 | Phone: 800-451-7087 | Fax: 800-215-6799
