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Secure Finance Application

Application Click here to download an application in pdf format

Application Click here to download an application in Word format

Please enter the name of your Dimension Funding representative (if known):

» Company Information

Company Name
DBA
Street Address
City
State
Zip
Telephone
Fax
Email
Date Established
Federal Tax ID
Business Type

» Principal Owner Information

Principal 1 Name
Social Security #
Street Address
City
State
Zip
Ownership %
Title
Principal 2 Name
Social Security #
Street Address
City
State
Zip
Ownership %
Title

» Bank References

Bank1 Name
Bank Account #
Type of Account
Contact Name
Contact Phone
Bank2 Name
Bank Account #
Type of Account
Contact Name
Contact Phone

» Vendor & Equipment Information

Vendor Name
Contact
Equip. Description
New or Used
Location
Total Cost

Delivery of this application bearing a facsimile signature(s) shall have the same force and effect as if the application bore an inked original signature(s). The applicant certifies that all information provided is true, correct and complete and that the account will be used solely for business or commercial purposes. The applicant, owner(s) and guarantor (if any) authorize Dimension Funding, LLC or its designee(s) or assignee(s) to obtain any information it may request from any business or consumer reporting agency(ies) or other sources that provide credit reports, account history information, credit and employment history or similar information; such authorization shall extend to update renewal of credit and for reviewing or collecting the account. The applicant acknowledges that, based upon such information and other factors which may apply, Dimension Funding, LLC or its assignee(s) or designee(s), in their sole discretion, may either grant or decline to grant credit.

By submitting this application, I also wish to continue to receive updates from Dimension Funding LLC. regarding our account. Information should be sent to the fax and/or email address given for the account.