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New Retailer Application
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Retailer Information
Legal Business Name
Business Name or DBA
Tax ID Number
Year Established
Website URL
Industry
Furniture & Mattress
Appliance
Home Electronics
Car Audio Electronics
Computers & Mobile Electronics
Auto Wheel & Tire
Auto Parts & Repair
Eyewear
Jewelry
Landscaping Tools & Outdoor Goods
HVAC
Elective Medical
Handheld Electronic Devices
Recreational Goods
Musical Instruments
Storage Sheds
Power Tools & Handheld Tools
Water Softeners & Filters
Primary Industry
Current Purchasing Options
Traditional (GE, Wells Fargo, etc.)
No Credit Needed Program
Lay Away
None
How did you hear about us?
Referral
Phone Call
Visit
Internet search
Email
Comments
Location Information
Location Name
Headquarters?
Country
US
CA
Phone Number
Street Address
Unit
City
State
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MP
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip Code
Primary Contact Person at Location
Position
Business Owner
Store Manager
Store Sales Staff
Store Finance Staff
Lease Contact Information
Store Email Address
Funding Email Address
Owner Information
First Name
Last Name
Work Phone
Mobile Phone
Email
User Account Creation
First Name
Last Name
Email Address
Phone Number
Username
Password
Password Confirmation
Bank Information
Bank Account Number
Institution Number
Transit Number
Routing Number
Bank Name
Submit Application