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Sales Information
*Name of Salesperson: 
*Don't know or don't have one, enter "None"
*Amount of Credit Requested:  $0-$5,000  $5,000-$25,000  $25,000+
Business Information
*Current Finance Customer:  Current Customer  Past Customer  New Customer
Finance Customer Number: 
*Type of Business:  Individual    Proprietorship    Corporation    Other
*Years in Vending:  Not in Vending    New Vendor    1-2 years    3-4 years    5+ years
Number of Routes:     Number of Locations: 
Number of Machines:     Annual Vending Sales: 
Customer Name (Legal): 
*First Name: 
*Middle Initial: 
*Last Name: 
*Business or DBA Name:  *If none, enter "None".
*Business Address Line 1: 
Business Address Line 2: 
*City: 
*State/Province: 
*Zip/Postal: 
*Country: 
*Business Phone:   -  - 
*Cell Phone/Alternate:   -  - 
Business Fax:   -  - 
Owner/Authorized Signer 1: 
*First Name:    
*Last Name: 
*Social Security Number:   -  - 
Owner/Authorized Signer 2: 
First Name:    
Last Name: 
Social Security Number:   -  - 
Credit Information
Number of Years at Address: 
   Home Owner    Renter
Same as business address: 
Yes    No
Address Line 1: 
Address Line 2: 
City: 
State/Province: 
Zip/Postal: 
Country: 
Phone:   -  - 
Nearest Relative not living with Customer: 
First Name: 
Last Name: 
Relationship: 
Phone:   -  - 
Employment Information
*Employed Outside of Vending?    Yes    No
Employer 1
       Employer:     Salary: 
       Position:     Years Employed: 
       Phone:   -  - 
Employer 2
       Employer:     Salary: 
       Position:     Years Employed: 
       Phone:   -  - 
Trade References
Company Name:     Phone:   -  - 
Account: 
Company Name:     Phone:   -  - 
Account: 
Company Name:     Phone:   -  - 
Account: 
Important Notice
For purchases over $25,000 WFS will require the submittal of, 1) Last year's tax returns and/or 2) Current year to date Profit and Loss Statement. Please fax this information to our secure fax line: 515-271-8402. If you have any questions, please contact WFS at 1-800-236-2929.
Please review the Credit Report and Finance Application Submission Policies, as well as the Terms and Conditions of Use and Privacy Policy regarding the information that you provide to us.
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*Email Address: 
*Confirm Email Address: 
A thank you page will appear after submitted and also a confirmation email will be sent.
 
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