Corporation Credit Application Form - Free Download
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CREDIT APPLICATION
John Deere Construction PowerPlan
Phone: 800-323-8542 Phone: 800-634-9661
Fax: 800-826-8267 Fax: 800-436-3224
Dealership Name:
Salesman/Location: Dealer #: Date:
Applying for: RETAIL NOTE LEASE POWERPLAN MUNICIPAL
Fields marked with an asterisk (*) are required by law (USA PATRIOT ACT) when applying for revolving credit. Your application cannot be processed without this information.
APPLICANT INFORMATION -- Full legal name and address of Business -- Corporation, Partnership, Trust, Sole Proprietorship or Municipality
Business Name* DBA (if any) Federal Tax ID Number*
Physical Address* City* County* State* Zip*
Mailing Address (if different from above) City County State Zip
Business Phone # Fax # Home # E-Mail Address:
State in which the business is Registered or Incorporated* Date Business Incorporated, Partnership formed, or Sole Proprietorship Started Time at current address
Primary Applicant Information -- Personal, Officer, Partner, Member, or Municipal Contact Information
†(Required for all applications submitted on behalf of an organization) If applicable, signature required below.
First Name* Middle Name* Last Name* Title
DOB† Social Security #†
Physical Address of Primary Officer, Partner, Owner or Member (if different than above)
Physical Address* City* County* State* Zip*
Home Phone # Mobile Phone # E-Mail Address Are you a U.S. Citizen
Yes
No
Type of Business*
Trust^ Individual LLC^
General Partnership^
Limited Partnership^
(please check one)
S Corp
C Corp
Municipality
Sole Proprietor
Additional Owner(s), Partner(s), Member(s), and/or Officer(s) information -- Use a separate sheet listing name(s), title(s), % owned, address(es), phone #(s), SS #(s), and date(s) of birth.
CO-APPLICANT INFORMATION
(Required if spouse or person other than Primary Owner identified above has an interest in the business operation or assets listed below and is also a co-applicant.) If applicable, signature required below.
First Name* Middle Name* Last Name* Title
DOB† Social Security #†
Physical Address* City* County* State* Zip*
Phone # Fax # E-Mail Address Are you a U.S. Citizen
Yes
No
FINANCIAL INFORMATION AND BANK/LOAN REFERENCES -- NOTE: <*> indicates required information.
<*> Annual Gross Sales Net Income Net Worth
$ $ $
Bank Name ACCT# Phone # Contact Name
Equipment Finance Co. ACCT# Phone # Contact Name
Equipment Finance Co. ACCT# Phone # Contact Name
Equipment Finance Co. ACCT# Phone # Contact Name
# YEARS IN BUSINESS HAVE YOU EVER FILED BANKRUPTCY HAS A JUDGMENT EVER BEEN FILED AGAINST YOU
Yes No
Yes No
INSURANCE INFORMATION NOTE: not applicable to revolving credit.
Insurance Agency name Contact Name Policy # Phone # Fax #
Physical Address City County State Zip
If you do not have insurance would you like to have JD Sentry UltraGard Physical Damage Insurance quoted and applied to your payments
Yes
No
PRIMARY APPLICANT If you are applying for a PowerPlan account, you acknowledge that you have received a true copy of the credit agreement and agree to its terms.
By: X
Printed Name of Signer: Date:
Individually If primary applicant is a corporation or other form of legal entity, title of signer:
CO-APPLICANT
By: X
Printed Name of Signer: Date:
Individually If co-applicant is a corporation or other form of legal entity, title of signer:
PLEASE PRINT OR TYPE
(Page 1 of 2)
Please submit the two most recent years of accountant prepared corporate and/or personal financial statements and work in progress (jobs on hand) report with this application.
^If applying as an LLC, a copy of the Operating Agreement & Articles of Organization is required with this application, or Partnership Agreement if applying as a Partnership, or Trust Agreement if applying as a Trust.
Primary Owner Signature Individually -- Required for Corporation, LLC & Partnership in addition to the signature on behalf of the Organizational Applicant above (by signing, such Primary Owner shall be
personally liable for all transactions and obligations arising under any John Deere Financial account that may be approved by JDF pursuant to this Application.)
Notice to Applicant: You represent that the information given in the entire application, including all applicant names and any other information provided in this credit application is (1) true,
correct, and complete, and (2) provided for the purpose of obtaining credit in an amount set forth in the credit policies and practices of John Deere Financial, f.s.b. (JDF), Deere Credit, Inc.
(DCI), or John Deere Construction and Forestry Company (JDCFC) (collectively referred to as “we,” “us,” and “our”). You hereby authorize the release to us or our designee (and any assignee
or potential assignee thereof) (1) your credit information from any source including, but not limited to, your balance sheet, cash flow statements, and any income statement. The authorization
shall apply to this application and subsequently for the purposes of update, renewal, or extension of such credit and for reviewing or collecting the resulting account.
You understand that any decision to grant or deny an installment or lease application will be made by DCI or JDCFC in Iowa. You understand that any decision to grant or deny revolving credit
will be made by JDF in Wisconsin. You understand that this application may be used for obtaining credit or lease approval for any DCI or JDCFC product. Understand this account is for
commercial and government use only. Married applicants can apply for an individual account. You authorize us to share information with our affiliates, disclose financial information about you as
described in the credit agreement and further notices and disclosures sent to you, and to send you information by facsimile or other electronic means. You also agree that any notices or
disclosures can, at your option, be provided electronically to the last Internet address that you provided us. You further certify that you are authorized to sign on behalf of the applicant.
*** This Credit Application consists of two (2) pages. Notice to Applicant is continued on the next page. ***
CR2110492 (06/2011)
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